Swelling and pain appear when blood flow is delayed in states of “oketsu.” Until now “oketsu” as a circulatory disturbance has been studied from profiles of vascular resistance characteristics and blood fluidity. Blood fluidity is influenced by blood cell function, plasma ingredients and reactive oxygen. In this study, we administered the various Chinese herbal medicines, tokishakuyakusan, saikokaryukotsuboreito, tokakujokito, keishibukuryogan and juzentaihoto to determine the effect of these medicines on “oketsu” by observing reactive oxygen dynamics and blood fluidity in rats.SPF male Wistar rats weighing 200 g were used. Each experimental group was given feed containing 3% extract of one Chinese herbal medicine for1week. Blood samples were mixed with heparin, EDTA-2K or sodium citrate to block coagulation. Blood fluidity was measured with a Micro Channel Array Flow Analyzer (MC-FAN). A PA-20 examined platelet aggregation by the reaction to ADP, which activates platelet aggregation. Reactive oxygen dynamics were measured with a Free Radical Elective Evaluator (FREE).As a result, anti-oxidative ability and blood fluidity increased in all Chinese herbal medicine-administered groups. Furthermore, an inverse correlation between the fluidity of erythrocyte suspensions and anti-oxidative ability was shown. We speculate that an anti-oxidative influence of Chinese herbal medicines affected erythroid deformability or stickiness. In addition, tokishakuyakusan, tokakujokito and keishibukuryogan decreased platelet aggregation ability.This study shows that “oketsu” improves blood properties and suggests that Chinese herbal medicine improves decrease in blood fluidity, the causes of conditions such as thrombosis or embolism.

Decreased adherence to medications among the elderly has become a problem in recent years. To overcome this problem, the dispensing of one-dose packages of medicines has been suggested. The purpose of this study was to survey elderly outpatients in a regional hospital at the Tokachi Development and Promotion Bureau and to analyze the factors that influence patients’ preference for a one-dose package medicine. The dispensation of one-dose package medication was observed in 20% of elderly outpatients. A correlation between the percentage of dispensed one-dose package medications and the number of agents was observed. Furthermore, dispensing rates of one-dose package medications increased with aging. Within the various departments analyzed, one-dose packaging rate was high in the Departments of Cardiology and Psychiatry. In this study, the correlation between residential municipalities of outpatients and one-dose package medications was examined. In the municipalities with a high rate of aged individuals and high average of household members, one-dose package medication rate was low. Multivariate logistic regression analysis confirmed these factors as significant. That one-dose packaging rates increased with the number of drugs and aging are consistent with the notion that one-dose package medications are designed to increase drug adherence among the elderly. Interestingly, one-dose package dispensing rate was low in areas with advanced aging. Because aging in Japan is expected to advance in the future, it is important to survey one-dose package dispensations.

Objective: Currently, the creation of a pharmaceutical risk management plan (RMP) for new drug information is obliged to pharmaceutical companies.  The created RMP is published on the Pharmaceuticals and Medical Devices Agency (PMDA) website.  RMP is a useful information source to ensure drug safety by healthcare professionals, including pharmacists.  “Risk minimization activities” of the RMP are especially important elements for healthcare professionals because they describe measures to minimize risk to patients.  We conducted a cross-sectional survey of the description of the contents of “risk minimization activities” in the RMP.
Methods: The RMP of 177 drugs that had been published in February 22, 2016 were investigated.
Results: Total risks enumerated for the study drugs were 1,678.  “Routine risk minimization activities” constituted 92.0% of total risks.  The most listed item on “routine risk minimization activities” was “attention on the product labeling of the drug package insert” (91.3%).  Differences in the expression level on “attention on the product labeling” were observed.  On the other hand, the most listed item of “additional risk minimization activities” was “the creation of documents for healthcare professionals” (38.3%) and “implementation of Early Post-marketing Phase Vigilance” (27.1%).
Conclusion: A clear understanding of RMP by healthcare professionals is important.  In the RMP, “risk minimization activities” (especially “additional risk minimization activities”) are the most important contents for healthcare professionals, because they include information of documents created by the pharmaceutical company for patient safety.  The level of description of the contents of RMP varies between drugs.  It is essential that these descriptions be uniform the expression level to be easily and accurately utilized by healthcare professionals.

Scientific elucidation of “oketsu (blood stasis)” states is very important to understanding the diagnostic methods of oriental medicine. We investigated the correlation of blood fluidity to oketsu states, by micro channel array flow analyzer (MC-FAN). Twenty-seven female patients were divided into three groups: a non-oketsu group, a mildly affected group, and a severely affected group according to the diagnostic criteria of their oketsu syndrome. Immediately after collecting their venous blood, whole blood passage time was measured by MC-FAN. And we compared and investigated the correlation with degree of oketsu state, diagnostic criteria and changes of whole blood passage time after the administration of ku-oketsu drugs. As a result, whole-blood passage time of the mildly affected group and the severely affected group were significantly longer than that of the non-oketsu group, while the [an] improvement of blood fluidity was observed after medication. This study confirms that reduced blood fluidity is seen using MC-FAN in oketsu states, and that ku-oketsu drugs are able to improve these states.

BACKGROUND/AIMS: Mesalazine is an effective drug for treating ulcerative colitis (UC), but causes allergic symptoms in a few cases. Therefore, the objective of this study was to evaluate the usefulness of the drug-induced lymphocyte stimulation test (DLST) for the diagnosis of mesalazine allergy. METHODS: Patients with UC treated with mesalazine with or without a history of associated adverse events (AEs) were enrolled at Kyorin University Hospital from July 2016 to April 2017. RESULTS: The DLST was performed in 104 patients with UC, of which 24 had a history of AEs due to mesalazine treatment. The control value of DLST was 337.4±296.3 counts per minute (cpm) in the AE+ group and 408.0±371.9 cpm in the AE− group. The measured value of DLST was 578.8±424.7 cpm in the AE+ group and 476.5±471.8 cpm in the AE− group. The stimulation index (SI) was 243.9%±291.1% in the AE+ group and 119.8%±53.0% in the AE− group. The SI value and DLST positivity were significantly higher in the AE+ group than in the AE− group (P=0.030 and P=0.029, respectively). The test sensitivity and specificity were 0.240 and 0.805, respectively, and the false-positive and false-negative rate was 0.195 and 0.760, respectively. CONCLUSIONS: The DLST for mesalazine showed low sensitivity and high specificity, suggesting that it may be useful for the definitive diagnosis of allergy to mesalazine.
Colitis, Ulcerative ; Diagnosis ; Humans ; Hypersensitivity* ; Lymphocyte Activation* ; Lymphocytes* ; Mesalamine* ; Sensitivity and Specificity

We report a case of sleep terrors complicated with sleepwalking. The patient was 9-year-old boy who suddenly woke up, walked, or screamed in his sleep. These symptoms were sometimes induced by such as fever elevation or school events. In order to prevent injury while sleeping, he was suggested taking medicine to suppress the nocturnal behavior. After taking shokenchuto based on his findings of qi deficiency, the episodes gradually disappeared and the frequency of fever elevation decreased. In this report, we present the improvements of sleep parameters provided by overnight polysomnography, performed before and after treatment. Shokenchuto is known as one of the curative medicines for sleep terrors, but this is the first report showing objective therapeutic effects using overnight polysomnography.

We report a case of obstructive sleep apnea improved with the treatment both of Kampo medicine and Western medicine. The patient aged 52 years old was struggling with daytime drowsiness. Through the sleep test, he was diagnosed as severe obstructive sleep apnea (OSA) and was received a continuous positive airway pressure therapy (CPAP). Generally, positive air from CPAP applies through the nose and usage reports were recorded in the device. If having nasal congestion, it may be hard to continue CPAP. In this case he had a severe nasal congestion, and he nearly became CPAP failure. It was clear from the poor usage reports. Using Eppikajutsuto for nasal congestion, he felt decrease of nasal congestion. By switching to Shoseiryuto or kakkontokasenkyusin’i from Eppikajutsuto with reference to CPAP usage and nasal CT images, CPAP was continued effectively. Eventually, his daytime sleepiness disappeared.To continue CPAP, which is one of Western medicine, Kampo medicine was useful. On the other hand, to evaluate the effectiveness of Kampo medicine, Western medicine was necessary. CPAP reports and nasal CT images, which are Western medicine, contributed to the switch to Kampo medicine. This case showed the worth of the combined therapy of Kampo medicine with Western medicine.

We report two cases in which insomnia successfully treated with sansoninto alone or in combination and the effectiveness could be objectively evaluated with the portable sleep test. Case 1 was 40-year-old man who had suffered from arousal during sleep and daytime fatigue for several years. After taking sansoninto with ninjinto, his symptoms improved. Case 2 was 60-year-old woman who had suffered from a lack of deep sleep and daytime sleepiness. After taking sansoninto, she could get a deep sleep and could have less daytime sleepiness. In this report, we present that portable sleep test conducted before and after treatment confirmed that sleep quality improved. Sansoninto is one of the curative medicines for insomnia, but we believe this is the first report showing objective therapeutic effects using portable sleep test.