The Project for Improving Maternal and Newborn Care through Midwifery Capacity Development by Japan International Cooperation Agency (JICA) was initiated for capacity building through pre-and post-service midwifery training.
  Firstly, we have shared the concept of ideal midwifery care based on the definition of evidence-based medicine (EBM) with our counterparts, which involves the integration of the best research evidence with clinical expertise and patient values. In addition to evidence-based midwifery care, we tried to provide individualized woman-centered care.
  After sharing these concepts in our project sites, we tried to modify the lectures on the basic concepts of midwifery care in the Health Center Midwifery Training program, and care providers’ attitudes based on EBM in the Basic Emergency Obstetric and Neonatal Care Training program.
  Our trial is an essential first step towards the further reduction of maternal mortality in Cambodia.

Heberden's and Bouchard's nodes are clinical manifestations of osteoarthritis of the interphalangeal joints. Heberden's nodes typically affect the distal interphalangeal (DIP) and Bouchard's nodes, the proximal interphalangeal (PIP) joints of a fingers in patients with osteoarthritis. We describe osteoarthritis of the interpha­langeal joints in 3 women who were successfully treated with sokeikakketsuto. Case 1 : A 58-­year-­old woman presented with pain in the DIP joint of her left middle finger and was diagnosed with a Heberden's node. Case 2 : A 60­-year­-old woman presented with pain in the DIP joint of her left ring finger and was diagnosed with a Heberden's node. Case 3 : A 37­-year-­old woman presented with pain in PIP joint of her left ring finger and was diagnosed with a Bouchard's node. All women were successfully treated with sokeikakketsuto. In conclusion, sokeikakketsuto is a useful Kampo medication to treat mild-­to-­moderate pain secondary to bone, joint, or spinal conditions, as well as non-­steroidal anti­inflammatory drugs.

OBJECTIVEThe aims of this study were to determine the effects of heavy metals such as manganese on nicotinamideN-methyltransferase (EC 2.1.1.1) (NNMT) activity and to consider the possibility of involvement of NNMT activation in the pathogenesis of heavy metal induced Parkinson's disease.

METHODSNNMT activity in supernatants separated from brain, liver and kidney homogenates of 5 elderly male Wistar rats by centrifugation were measured by high performance liquid chromatography system with fluorescence. NNMT activity under the conditon of 0.5 or 5.0 mM Mn(2+), Fe(2+), Cu(2+) or Cd(2+) was compared with control (no metal ion existence).

RESULTSNNMT activities in rat brain, liver and kidneys were significantly decreased by Cu(2+), and those in the liver and kidneys were significantly decreased by Cd(2+). Mn(2+) reduced NNMT activity only in the liver. Fe(2+) had no effect on NNMT activity.

CONCLUSIONSNo metal increased NNMT activity in this study, contrary to our hypothesis. Further study is needed to clarify the reason why the effects of Mn(2+) and Fe(2+) which have a high relevance to Parkinson's disease on NNMT activity differ from those of Cu(2+) and Cd(2+).

Carpal tunnel syndrome is a common condition caused by compression of the median nerve. Patients usually present with numbness and pain along the distribution of the median nerve in the hand. We report 2 cases of carpal tunnel syndrome successfully treated with kakkonto after their pattern diagnosis. We treated a 57-year-­old women and a 59-­year-­old man. Two patients presented with hand pain and numbness and were diagnosed with carpal tunnel syndrome. Kakkonto treatment was successfully in two cases. We observed that median nerve compression persisted in these patients even after disappearance of numbness and pain ; therefore, we recommended operative management. The 2 patients underwent an operation for carpal tunnel syndrome. Kakkonto can be considered useful palliative treatment before considering operative management for numbness and pain in the patients with carpal tunnel syndrome.

We present two cases of night sweats due to eiefuwa (deficiencies of nutrients and defenses) that were suc­cessfully treated with Kampo medicine. Case 1 was that of a 64-­year-­old man with perspiration during sleep and slight fever, and Case 2 was that of a 78­-year-­old man with perspiration during sleep and common cold­-like symptoms. Case 1 was administered with saikokeishito, and his symptoms quickly disappeared. Case 2 was administered with common cold drugs and saikokeishito initially, but the treatment was ineffective. Therefore, keishito was administered, and the patient's symptoms disappeared within 2 days. Sweating and common cold-­like symptoms were successfully treated with Kampo medicine for the diagnosis of eiefuwa. Further, we discuss the various descriptions of eiefuwa in the literature.

Poor eating is a life-threatening condition in senior citizens. Herein, we report a case of poor eating due to stomach yin deficiency (wei yin xu), which was successfully treated with bakumondoto. The patient was a 91-year-old woman who expected treatment for her poor food intake. She was diagnosed as poor eating with stomach yin deficiency and was administered with bakumondoto, which increased her food intake and weight. To treat poor eating with Kampo medicine, rikkunshito and various other Kampo drugs are commonly used. In this case, bakumondoto, which is usually used for respiratory diseases such as dry cough, was effective. Bakumondoto is useful for stomach yin deficiency of poor eating.

Team-based learning (TBL) is an educational method developed to cultivate the ability to solve problems by learning and applying knowledge on one's own, as well as the ability to make decisions, take responsibility, and collaborate by working on issues in small groups. TBL in Kampo medicine was held as a special program : active learning at the 71st Annual Meeting of the Japan Society for Oriental Medicine. A total of 57 students participated in the TBL session. The theme of the session was the common cold with the theory of yin and yang. According to the results of a questionnaire survey, the students answered that they were able to understand the flow of diagnosis in Kampo medicine, which was the goal of the course. As a bridge from classroom lectures to clinical practice, TBL in Kampo medicine was considered to be useful in Kampo medical education.