During the 23 years since this pain clinic was founded, 29, 458 patients have been treated here (about 385, 000 patient visits in total). In the earlier days, patients with whiplash injury (posttraumatic neck syndrome) were predominant. More males than females visited our clinic in those earlier days. Several years after this clinic opened, the percentage of female patients became higher (55% or more) than the percentage of male patients. Reflecting the social trend of an increase in the percentage of elderly people in the total population, the percentage of patients between 60 and 80 years of age has been increasing. Patients who visit this clinic live primarily in Osaka Prefecture. However, it is not uncommon that patients living in other prefectures of the Kinki district visit this clinic. Although patients visit our clinic because of various complaints, they often suffer from chronic, intractable complaints, such as low back pain, combined pain of the lower back and legs, and postherapuetic neuralgia. They often visit our clinic as a last resort for healing, after having consulted many other institutions. The duration of sickness among patients who visit our clinic is long (often over 5 years). Although the methods of treatment and the patients' responses vary, depending on their diseases, the combination of nerve block with acupuncture seems to be more effective on pain. We have utilized various techniques of acupuncture, including the in situ needle acupuncture, low-frequency therapy, SSP therapy, laser therapy and hyperthermia.

Enrolled in our study were 16 seriously handicapped persons (9 males and 7 females) institutionalized in our medical center. They were 20 to 58 years of age (mean 35 yrs). In the previous study, we found they had no evidence, serological or clinical, of osteomalacia but were verified as having significantly low bone mineral density (BMD) at the calcaneus and lumbar vertebrae. Serum levels of 25-OH-vitamin D were low and positively correlated with the lumbar vertebral BMD. Thus we postulated that low BMD was at least partly due to the lack of ultraviolet exposure. In the present study, the lumbar vertebral BMD of the above subjects were measured before and after increasing their exposure to sunlight. We found that mean lumbar BMD increased signigicantly from 770 mg/cm² to 786 mg/cm² (P<0.05, Wilcoxon, paired test). The Z-score also increased significantlyfrom 78 ± 13% to 80 ± 12%(P<0.05, Wilcoxon, paired test).
These findings suggest low BMD could be corrected to some extent by increasing sunlight exposure of institutionalized persons. Former members of farming communities who are retired, handicapped, or otherwise limited to indoor activity, can also recover their BMD and prevent osteoporosis by an increased daily exposure to sunlight.

A statistical study on effects of laser-puncture was carried out. In addition, an attempt was made to compare between the effect of acupuncture and this method. The treatments were under-taken for various chronic and acute cases with pain. In the laser-puncture treatment, two types of laser (i, e. low energy 10mW laser and 70mW sharp laser) were used. Laser-beam was given to 20-30 points which were located in painful areas, innervating nerve areas and remote areas for 40 sec for each.
In the open study, 10mW laser-puncture was effective (including ‘rather effective’) in 64% of the cases, and 70mW laser-puncture 73%. In the blind test, ‘the day’ evaluation showed that the laser-punctures were more effective than placebo treatment: 10mW laser-puncture was effective in 80% of the cases, and placebo in 67%. 70mW laser-puncture was effective in 87% of them, and placebo in 80%. In situ acupuncture was effective in 97%, and no effect was seen in 7%.
Only ‘the day’ evaluation in the open study showed that 70mW laser-puncture was more effective than 10mW one. In the blind best, 10mW and 70mW laser-puncture were more effective than placebo, and in situ acupuncture was more effective than the laser-punctures, but there were no significant differences among the three treatmets.

OBJECTIVE: To examine the surgical-pathological predictors of para-aortic lymph node (PAN) metastasis at radical hysterectomy, and for PAN recurrence among women who did not undergo PAN dissection at radical hysterectomy. METHODS: This is a retrospective analysis of a nation-wide cohort study of surgically-treated stage IB–IIB cervical cancer (n=5,620). Multivariate models were used to identify independent surgical-pathological predictors for PAN metastasis/recurrence. RESULTS: There were 120 (2.1%) cases of PAN metastasis at surgery with parametrial involvement (adjusted odds ratio [aOR]=1.65), deep stromal invasion (aOR=2.61), ovarian metastasis (aOR=3.10), and pelvic nodal metastasis (single-node aOR=5.39 and multiple-node aOR=33.5, respectively) being independent risk factors (all, p<0.05). Without any risk factors, the incidence of PAN metastasis was 0.9%, while women exhibiting certain risk factor patterns (>20% of the study population) had PAN metastasis incidences of ≥4%. Among 4,663 clinically PAN-negative cases at surgery, PAN recurrence was seen in 195 (4.2%) cases that was significantly higher than histologically PAN-negative cases (2.5%, p=0.046). In clinically PAN-negative cases, parametrial involvement (adjusted hazard ratio [aHR]=1.67), lympho-vascular space invasion (aHR=1.95), ovarian metastasis (aHR=2.60), and pelvic lymph node metastasis (single-node aHR=2.49 and multiple-node aHR=8.11, respectively) were independently associated with increased risk of PAN recurrence (all, p<0.05). Without any risk factors, 5-year PAN recurrence risk was 0.8%; however, women demonstrating certain risk factor patterns (>15% of the clinically PAN-negative population) had 5-year PAN recurrence risks being ≥8%. CONCLUSION: Surgical-pathological risk factors proposed in this study will be useful to identify women with increased risk of PAN metastasis/recurrence.
Cohort Studies ; Female ; Humans ; Hysterectomy ; Incidence ; Lymph Nodes ; Neoplasm Metastasis ; Odds Ratio ; Recurrence ; Retrospective Studies ; Risk Factors ; Uterine Cervical Neoplasms

Objective: Crimes related to falsified medicines for medical use are of international concern and becoming increasingly sophisticated. Therefore, in this study, we investigated information on education and training/enlightenment activities on falsified medicines worldwide that are open to the public on the Internet to contribute to medical/pharmaceutical professionals’ and consumers’ education regarding falsified medicines in Japan.Methods: In April 2023, we searched the information written in English and Japanese on education and training/enlightenment activities on falsified medicines using the Internet.Results: We surveyed several countries and obtained important findings. In particular, the World Medical Association (WMA), the International Pharmaceutical Federation (FIP), and the World Health Professions Alliance (WHPA) released programs for healthcare professionals. The US news programs, the US Department of Justice, and the Council of Europe released consumer warning videos. Japan issued the “Guidelines for Good Distribution Practice (GDP)” to the pharmaceutical distribution industry in 2018. Additionally, US and UK medicine regulators and the International Criminal Police Organization (ICPO) offered programs for professionals such as police and customs officers, and public prosecutors.Conclusion: These programs contain useful information not only for medical/pharmaceutical professionals in Japan but also for consumers. However, many are provided by foreign governments or international organizations, while few are from Japan. Therefore, to prevent the distribution of falsified medicine in Japan, educational institutions must further strengthen education and training/enlightenment activities and develop and publish educational tools for falsified medicines.