We report two cases of myoclonus following the administration of gabapentin for neuropathic pain in the end stage of malignancy. Patient 1: A septuagenarian woman with sarcoma of the uterus was admitted to our hospice. She complained of severe neuropathic pain in her left leg caused by an invasive lumbar tumor. To reduce the neuropathic pain, she was administered 200mg of gabapentin daily. Four months later, the gabapentin was increased to 400mg daily due to worsening pain in her left leg. Three days later, she felt muscle weakness in her left arm and frequent muscle twitches were observed even during sleeping. Myoclonus associated with gabapentin administration was suspected. The myoclonus disappeared after cessation of gabapentin for 2 days. Patient 2: An octogenarian man with renal cell carcinoma was admitted to our hospice. He was administered 200mg of gabapentin daily to reduce the neuropathic pain felt in his back and bilateral leg due to a metastatic tumor of a para-aortic lesion. On the next day, frequent muscle twitches were observed in his extremities and upper trunk while he was sleeping. Myoclonus associated with gabapentin administration was suspected, which disappeared within one day following cessation of the drug. Myoclonus is a rare side effect of gabapentin, but it may occur even with the low-doses given to patients with end-stage malignancy. Although the pathogenic mechanism of induction of myoclonus by gabapentin was suspected to be heterogeneous, discontinuation of gabapentin should lead to rapid resolution of symptoms. Palliat Care Res 2010; 5(1): 308-313

Purpose: This study aimed to evaluate the effect of continuous patient education on pain control in outpatients based on changes in pain intensity scores and occurrence of opioid-related adverse effects. Methods: The education intervention was conducted in the following phases; 1) interview at the first visit for opioid introduction, 2) telephone follow-up at home 3 to 7 days after introducing opioid analgesics, and 3) interview at the next visit. Pain intensity scores; frequency of rescue dose; and occurrence of adverse opioid-related effects such as constipation, nausea, and drowsiness were compared among the three intervention phases. Results: When comparing data at phase 2 and 3 with those at phase 1, daily maximum pain score decreased significantly, frequency of rescue dose and opioid dosage increased significantly, and occurrence rates of constipation decreased. Conclusion: Continuous patient education by pharmacist intervention based on not only patient visit interviews but also telephone communication on non-visiting days can improve the pain intensity scores and reduce the rate of opioid-related adverse effects for cancer outpatients.

Objective: Anti-Human cytomegalovirus (HCMV) activity of Kumazasa (Sasa senanensis Rehder) extract were investigated in the human embryonic lung (HEL) fibroblast cell.
Method: This study examined the effect of hot water extract from Sasa senanensis Rehder on HCMV replication, viral-specific major immediate early (IE) gene expression, and protein synthesis.
Results: Treatment of HCMV-infected HEL cells with that Sasa senanensis Rehder extract inhibited the cytopathic effect and viral production in a dose-dependent manner. Further, real-time RT-PCR assay and Western blotting analysis revealed that Sasa senanensis Rehder extract decreased expression of the HCMV IE gene in virus-infected HEL cell.
Conclusion: These results suggest that Sasa senanensis Rehder extract have anti-HCMV activity by inhibitting of IE gene expression.

The WFAS Houston 2016 annual conference was held in the Royal Sonesta Hotel, Houston, Texas, USA from 31 October to 2 November 2014. The theme of the conference was "East Meets West -Shaping the Future of Healthcare", and more than 900 acupuncture practitioners and scientists participated. The number of papers presented was 216, including 6 keynote lectures. Papers from Japan numbered 11.
At the Executive Committee (EC) meeting, 39 of the 76 EC members were present (10 EC members sent a letter of attorney in advance), including 3from Japan. Although Tokyo was approved as a host city of WFAS 2016 last year, we proposed changing the venue to the Tsukuba International Congress Center, which was approved.

Objective: Anti-human cytomegalovirus (HCMV) activity of 5 compounds, especially tricin, isolated from Kumazasa extract were investigated in the human embryonic lung (HEL) fibroblast cell.
Method: This study examined the effect of tricin on HCMV replication, viral-specific major immediate early (IE) gene expression, and protein synthesis.
Results: Pretreatment of HEL cells before HCMV infection with tricin inhibited viral production in a dose-dependent manner, as well as posttreatment of HCMV-infected HEL cells with tricin. Real-time RT-PCR assay and Western blotting analysis indicated that tricin decreased expression of the HCMV IE gene in virus-infected HEL cell.
Conclusion: These date suggest that the primary mechanism of anti-HCMV activity for tricin, isolated from Kumazasa hot water extract, inhibit IE gene expression.

Dynamic X-ray (DXR) is a functional imaging technique that uses sequential images obtained by a flat-panel detector (FPD).This article aims to describe the mechanism of DXR and the analysis methods used as well as review the clinical evidence for its use. DXR analyzes dynamic changes on the basis of X-ray translucency and can be used for analysis of diaphragmatic kinetics, ventilation, and lung perfusion. It offers many advantages such as a high temporal resolution and flexibility in body positioning. Many clinical studies have reported the feasibility of DXR and its characteristic findings in pulmonary diseases. DXR may serve as an alternative to pulmonary function tests in patients requiring contact inhibition, including patients with suspected or confirmed coronavirus disease 2019 or other infectious diseases. Thus, DXR has a great potential to play an important role in the clinical setting. Further investigations are needed to utilize DXR more effectively and to establish it as a valuable diagnostic tool.

Dynamic X-ray (DXR) is a functional imaging technique that uses sequential images obtained by a flat-panel detector (FPD).This article aims to describe the mechanism of DXR and the analysis methods used as well as review the clinical evidence for its use. DXR analyzes dynamic changes on the basis of X-ray translucency and can be used for analysis of diaphragmatic kinetics, ventilation, and lung perfusion. It offers many advantages such as a high temporal resolution and flexibility in body positioning. Many clinical studies have reported the feasibility of DXR and its characteristic findings in pulmonary diseases. DXR may serve as an alternative to pulmonary function tests in patients requiring contact inhibition, including patients with suspected or confirmed coronavirus disease 2019 or other infectious diseases. Thus, DXR has a great potential to play an important role in the clinical setting. Further investigations are needed to utilize DXR more effectively and to establish it as a valuable diagnostic tool.

Current evidence for the usefulness of prophylactic antiemetic drugs in opioid-induced nausea and vomiting (OINV) in cancer patients receiving opioid analgesics is limited. Further, antiemetic prophylaxis is not considered necessary in the Guideline for Cancer Pain Management by the Japanese Society of Palliative Medicine. However, prevention of side effects such as OINV is important when opioid analgesics are administered for adequate pain management and to maintain adherence. Cancer patients expect us to study factors affecting OINV and effective prophylactic measures for the condition. We retrospectively analyzed electronic records in our hospital. We found that female sex and the use of prophylactic antiemetics, chemotherapeutic agents, and steroids were statistically significant factors associated with opioid-induced nausea, and that female sex and radiation therapy were significant factors associated with opioid-induced vomiting. Especially in females, the frequency of nausea was significantly reduced in the group that received chemotherapy with antiemetics on the same day of receiving opioid analgesics, compared to the groups that did not receive chemotherapy, or that did not receive antiemetics but received chemotherapy. These results suggest that, especially in females, administering chemotherapy along with antiemetics on the same day may be one possible prophylactic measure for OINV.

At Anjo Kosei Hospital, all staff has been working concertedly on a project to establish a community hospital in line with our future vision. Hospital staff in charge of the Medical Affairs Division has been involved in measures aimed at achieving the slogan “health and happiness of local residents” as part of this project. To address this, three goals were set as follows: improvement of recoveries in accounts receivable management, a reduction of money held in trust, and a decrease in the number of outsourced transactions. To achieve the goals described above, the following specific measure were carried out: (1) collection of accounts receivable using convenience store settlement; (2) collection of high-cost medical expenses by wider use of Eligibility Certificates for Ceiling-Amount Applications and promotion of the Major Medical Cost Loan System for national health insurance holders; and (3) support in acquiring family registration for nonregistered family members and for health insurance benefits. Recoveries of accounts receivable through convenience store settlement was about 90,000 yen/month, and our support activities for family registration and health insurance benefits provided the recoveries of about 80,000 yen/month. Furthermore, the promoted use of the certificate and loan system resulted in recoveries of about 17 million yen/year. The average commission fee and number of outsourcing was 890,188 yen and 12 cases, respectively, from April to August 2016. However, in 2017, it was 305,615 yen and 10 cases, respectively. Our project aimed at achieving slogan-elicited patient voluntary payment of medical expenses, leading to improved recoveries, with reduced money held in trust and fewer outsourced transactions.