Introduction
The questionnaire survey was conducted among medical interpreters to clarify the duties of medical interpreters and the contents of training programs, and to analyze the challenges in practice.
Methods
The self-reported questionnaires were distributed to NPOs of medical interpreters, local international exchange associations, and hospitals with medical interpreters. They were directly collected to authors and analyzed.
Results
The number of valid responses was 284 (response rate: 33.4%). 46.1% of the respondents had worked as medical interpreters for 5 years or more. There were a few fulltime workers and 76.4% worked as a part-time interpreters. The respondents could interpret 14 languages including sign language. Only 8.5% of them had worked more than 20 times per month, while 68.3% worked less than 4 times per month. 54.4% of the respondents have had training of medical interpreting for more than 20 hours. The respondents answered their difficulties as medical interpreters between medical providers and foreign patients.
Discussions
This study was targeted at medical interpreters and revealed that many medical interpreters were working at hospitals and other health facilities. The training programs to develop knowledge, skills and ethical conduct are urgently needed to establish the professionalism of medical interpreters. The coordinators are essential to advocate the roles of medical interpreters to medical providers and foreign patients, and to support medical interpreters.

The aim of the current nationwide survey was to investigate the Kampo medicine experiences of Japanese physicians working at hospitals designated as core cancer centers by the Ministry of Health, Labour and Welfare. Among the 900 physicians surveyed, 92.4% reported having prescribed Kampo medications, of whom 73.5% reported having prescribed them for cancer patients. Despite this high percentage, only 28.7% of the physicians had studied Kampo medicine.
This survey found that over 40% of physicians in each generation had no intention of learning Kampo medicine. When asked to categorize their expectation of Kampo efficacy, about 30% said they had an ‘expectation’, a ‘no and yes expectation’, and ‘no expectation’ respectively.
However, physicians who had experience learning Kampo medicine had more expectation than physicians who had not. And the same expectation tendency for prophylaxis treatment was shown in physicians with that experience and those without. This difference is disadvantageous to patients. We therefore believe it necessary to create an environment in which physicians can learn Kampo medicine and methodology, which engenders cooperation between Kampo specialists and Japanese physicians in the treatment of cancer.

The purpose of this study was to examine the relation between body composition and athletic performance of long distance relay runners in a four week weight reduction program. Six male collegiate runners, aged 19.0 ± 0.9 years, participated in this study. Body water content and fat free mass (FFM) were measured by bioelectrical impedance spectroscopy.The weight loss by 4.1% of the initial body weight consisted of decreases in FFM and fat mass (54% and 46% respectively). Percentage of body fat did not change significantly by the end of the fourth week. The total body water (TBW) loss comprised of intracellular water (ICW) and extracellular water (ECW) at the end of the fourth week, and TBW loss and FFM loss were nearly the same values. Isokinetic muscular strength of right thigh, maximal oxygen intake (VO₂max) and total treadmill running time (maximal workout time) measured did not show any significant change. These results indicate (1) half of the weight loss consisted of decrease in FFM, (2) TBW loss was due to the reduction of ICW and ECW, (3) the content of FFM loss was considered to be body water, and (4) there was no impact on muscular strength of right thigh, VO₂max or maximal workout time.

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.

Phagocytic cells, polymorphonuclear leucocytes and macrophages, play an important role in non-specific cellular immunity, which is the first line of defense against infectious diseases. The purposes of this study were to clarify the combined effects of forced exercise and sleep disturbance on non-specific cellular immunity in mature rats, and to compare the effects between forced and voluntary exercise. Non-specific cellular immunity represented by the yield of cells from bronchoalveolar lavage and the superoxide-generating capacity of alveolar macrophages was investigated using mature rats.
Male Wistar rats (11 weeks old) were divided into 5 groups:
1) Training group ; exercised on a treadmill at a belt speed of 35 m/min for 15 min/day,
2) Jet Lag group ; disturbance of the sleep cycle by day/night time shifts at 2-week intervals,
3) Training+ Jet Lag (T + J) group ; exercised on a treadmill with sleep disturbance, a model identified by our research group to simulate chronic fatigue, 4) Voluntary group ; housed with running wheels, and 5) Control group ; housed under sedentary conditions.
Body weight and food consumption measured during the experimental period showed coincidental changes. After 6 weeks of the experiment, the rats were sacrificed at the age of 17 weeks. Negative effects on non-specific cellular immunity were observed in the training group, and the rats were also slightly affected by sleep disturbance (Jet Lag group) . These negative effects seemed to be cumulative in the T+J group. In contrast, significant positive effects were observed in the voluntary group.
These results suggest that stress, forced exercise and sleep disturbance negatively affect non-specific cellular immunity, and that voluntary exercise is able to enhance immunity even if it is started after maturation.

  Our palliative care team intervened in a patient with sciatica resulting from metastasis to sacral bone after surgery for rectal cancer. Rapid pain control and a change in the route of rescue drug administration from the stoma were needed. Partial opioid rotation was performed. The dose of 25.2 mg in 72 hours in a transdermal fentanyl patch decreased to 16.8 mg in 72 hours, and the dose of 3.6mg in an hour by continuous intravenous injection of morphine was added. The change in the rescue root to intravenous administration by a patient-controlled analgesia pump gave the patient relief from his pain. He was able to attend his daughter's wedding. His family were all pleased with the relief provided. The advantages of this partial opioid rotation are summed up in the following three points: (1) The required time is relatively short; (2) It can be expedient for analgesia due to the addition of different opioids; and (3) The partial opioid rotation produces fewer adverse effects than a full opioid rotation. Adjustment of the amount of drugs for pain relief in cancer patients is important with the situations of the patient and the family taken into consideration fully.

We describe three cases of insomnia due to a feeling of heat in parts of the body, successfully treated with saikokeishito. Case 1 was a 50-year-old man who felt hot in his trunk and extremities at night. Case 2 was a 57-year-old women with osteoarthritis in the fingers who felt hot in her back at night. Their heat/pain was regarded as shisetsuhanto, or vexing pain in the extremities as described in “Shang Han Lun.” Case 3 was another 57-year-old woman who reported hot flushes both day and night. She did not have vexing pain in her extremities, but developed a rash. Although three patients felt hot, they all felt chill when they took off a blanket. Their heat vexation and intolerance of cold were considered as zokansonetsu, as seen in saikokeishito syndrome. They had kyokyokuman, or objective tenderness in the hypochondrium. However, they differed in shinkashiketsu, or tightness below the heart, another characteristic physical findings of saikokeishito : case 1 had stuffiness and rigidity below the heart and abdominal muscle contracture, case 2 had hardness and stiffness in zhong wan (middle segment of the stomach), and case 3 had mild stuffiness and rigidity below the heart, in terms of signs classically reported by Japanese doctors in the Edo period. These findings may suggest that saikokeishito has a wide range of indications. The three cases shared several characteristics, such as during menopause, without cold limbs, moderate or hypofunctional body energy, and alternating heat and chills. Saikokeishito could be a good medicine to treat patients suffering from insomnia with such symptoms, especially during menopause.

The first examination of the new board of the Japanese cardiovascular surgery took place in 2022. As it is a transitional period for the new system, many doctors are not familiar with the changes and details of the new system, and some have their concerns. Here, we held a round-table discussion with doctors who actually took the new board of the Japanese cardiovascular surgery under the new system, and we summarized their opinion.

Struma ovarii is a rare tumor that is defined as an ovarian teratoma with a thyroid tissue component exceeding 50%. Most of these tumors are benign, with malignant struma ovarii occurring in <1% of patients. Here, we describe the case of a 49-year-old female patient with malignant struma ovarii who developed thoracic spine metastasis. She had undergone an oophorectomy and was diagnosed with struma ovarii 10 years previously. She had remained recurrence-free thereafter. At 49 years of age, she developed low back pain and was admitted to our hospital for evaluation of a spinal tumor at the Th7 level. An emergency bone biopsy led to a diagnosis of metastasis from malignant struma ovarii. External beam radiotherapy inhibited further tumor growth and there was no resulting muscle weakness. This is the first report of spinal metastasis occurring 10 years after resection of struma ovarii, indicating the need for long-term follow-up.
Biopsy ; Diagnosis ; Emergencies ; Female ; Humans ; Low Back Pain ; Middle Aged ; Muscle Weakness ; Neoplasm Metastasis* ; Ovariectomy ; Radiotherapy ; Recurrence ; Spinal Neoplasms ; Spine ; Struma Ovarii* ; Teratoma ; Thyroid Gland

BACKGROUND/AIMS: It is often difficult to manage acute cholecystitis after metal stent (MS) placement in unresectable malignant biliary strictures. The aim of this study was to evaluate the feasibility of endoscopic ultrasonography-guided gallbladder drainage (EUS-GBD) for acute cholecystitis. METHODS: The clinical outcomes of 10 patients who underwent EUS-GBD for acute cholecystitis after MS placement between January 2011 and August 2018 were retrospectively evaluated. The procedural outcomes of percutaneous transhepatic gallbladder drainage (PTGBD) with tube placement (n=11 cases) and aspiration (PTGBA) (n=27 cases) during the study period were evaluated as a reference. RESULTS: The technical success and clinical effectiveness rates of EUS-GBD were 90% (9/10) and 89% (8/9), respectively. Severe bile leakage that required surgical treatment occurred in one case. Acute cholecystitis recurred after stent dislocation in 38% (3/8) of the cases. Both PTGBD and PTGBA were technically successful in all cases without severe adverse events and clinically effective in 91% and 63% of the cases, respectively. CONCLUSIONS: EUS-GBD after MS placement was a feasible option for treating acute cholecystitis. However, it was a rescue technique following the established percutaneous intervention in the current setting because of the immature technical methodology, including dedicated devices, which need further development.
Bile ; Cholecystitis, Acute ; Constriction, Pathologic ; Dislocations ; Drainage ; Gallbladder ; Humans ; Retrospective Studies ; Stents ; Treatment Outcome