The purpose of this study was to investigate changes in muscle strength of the quadriceps femoris after intraarticular acupuncture treatment of the affected joint in subjects with unilateral osteoarthritic knee. Isometric muscle strength was measured by standard dynamometry at 90 degree knee flexion when the subjects contracted the quadriceps muscle slowly and maximally without any pain.
In the preliminary experiment, the repeated measurement yielded a high reliability coefficient (correlation coefficient r=0.95, there is no significant difference between the two means) in the affected knee as well as the normal side for 19 patients with osteoarthritic knee.
Nine subjects, whose muscle strength of the affected side had fallen by more than 20% compared with the normal side, participated in the study. An acupuncture needle was inserted into the point where the tenderness of the affected meniscus was marked. The results revealed a noticeable increase in muscle strength of the quadriceps femoris in the affected side from 14.3±2.2kg before acupuncture to 22.9±3.0kg after intraarticular acupuncture (p<0.001), with no significant change in the normal side from 26.0±2.4kg to 27.1±2.8kg (p>0.05).
A hypothesis was formulated that the dicreased muscle strength of the quadriceps femoris in the osteoarthritic knee results from reflex inhibition from joint receptors and that intro-articular acupuncture has a disinhibition effect on this inhibition of the extensor muscle activity.

The aim of this study was to investigate effects of acupuncture treatment on the improvement of visual acuity.
Six patients (male: 5, femal: 1, aged: 20-24) in the department of Ophtalmology were diagnosed with myopia grevis.
Used acupoints were EX-HN4, Jingming (B1), Hegu (Li4), Feugchi (G20), which were stimulated with the leaving needl techniqe for 10 minutes.
Acupuncture treatment was performed everyweek.
After 10 times treatment, the effect of acupuncture on visual acuity was evaluated.
As a result, three patients showed a remarkable improvement of the visual acuity and others not subsequently, the improved patients observed for 5 to 7 weeks without treatment in order to examine the durability of acupuncture effects.
While, the other three patients were treated with the electro-acupuncture instead of the leaving needl technique.
The visual acuity of the patients in whom acupuncture effective declined without treatment, but their visual acuity was kept at on higher level than before treatment.
On the other hand, the visual auity of the other patients improved by using electro-acupuncture.
These results suggest that acupuncture treatment is effective in improbvement of visual acuity and the effect remains for a certain period, and electro-acupuncture is effective when we do not get effect on vusual acuity with the leaving needle techniqe.

In recent years, an increasing number of researchers have warned that depltion of the Earth's ozone layer by chlorofluorocarbons allows extra ultraviolet radiation from space to strike our planet, causing a rise in the incidence of skin cancers and precancerous dermatoses worldwide. This motivated us to perform a series of screening for skin cancers on the inhabitants at age 40 and above of the Saku District, Nagano Prefecture, where the intensity of the sun's harmful ultraviolet radiation is thought to be relatively high.
The first screening was carried out from 1993 through 1995. The number of subjects totaled 7, 528-2, 658 men and 4, 870 women-which represents 7.4% of the populace. Of the total, 67 people had a histopathological examination. The result revealed that there were four cases of malignancy and 45 cases of precancerous dermatosis. The malignant cases were made up of one case of malignant melanoma and three cases of basal-cell carcinoma, while the precancerous cases were one case of Bowen's disease and 44 cases of solar keratosis.
The follow-up examination was conducted in 1996 on 93 subjects (40.6%) of the 229 examiness who had been found to need to be watched in the first screening. Biopsy was indicated in five subjects. Treatment was suggested to 11 subjects. A visit to the department of dermatology at Sake Central Hospital was recommended to 10 people. Further observation was needed in 24 cases.
The screening project for skin cancers under a long-range plan would raise awareness of the diseases among the people and contribute to the early detection, treatment and prevention of various forms of skin cancer. It could also serve the purpose of protecting the environment from deterioration on n global srnle.

The purpose of this study was to examine the relationship of the Rohrer index and physical activity on motor function. The subjects were 143 elementary school children in the 5th and 6th grades. Motor function was measured based on musculoskeletal examination. The Rohrer index was calculated from height and weight, and ≥140 was defined as a tendency to be overweight. Physical activity was investigated using a self-reported questionnaire, the WHO Health Behaviour in School-aged Children in Japanese version (HBSC-J). A total of 130 students and their parents agreed to participate in this study, and the data of 127 students were analyzed. The main results were as follows: 26 students had a Rohrer index ≥140, and 60 students (47.2%) had abnormalities in one or more items of motor function. In particular, there were many who reported “Impossible to fully squat” and “Limitation of standing forward flexion”. When compared by sex, “Impossible to fully squat”, “Limitation of standing forward flexion”, and “Pain in shoulder” were particularly frequent in boys. The Rohrer index was particularly high in those who reported that it was “Impossible to fully squat”, but it was not associated with HBSC-J. “Impossible to fully squat” was particularly low in HBSC-J (days of Moderate to vigorous Physical Activity and frequency of Vigorous Physical Activity). The results suggested that children of impossible to fully squat is a lot of low activity and obesity. In conclusion, children who are unable to squat should be followed up to promote physical activity and improve obesity.

Background/Aims: A subgroup analysis was conducted in Japanese patients with moderate to severe ulcerative colitis (UC) enrolled in the phase 3 VISIBLE 1 study, which evaluated the safety and efficacy of a new vedolizumab subcutaneous (SC) formulation. Methods: Eligible patients received open-label infusions of vedolizumab 300 mg intravenous (IV) at weeks 0 and 2 in the induction phase. Patients with clinical response by complete Mayo score at week 6 entered the double-blind maintenance phase and were randomized to vedolizumab 108 mg SC every 2 weeks, placebo, or vedolizumab 300 mg IV every 8 weeks. The primary endpoint was clinical remission (complete Mayo score ≤ 2 points; no individual subscore > 1 point) at week 52. Results: Of 49 patients who entered the induction phase, 22 out of 49 patients (45%) had clinical response at week 6 and were randomized to vedolizumab 108 mg SC (n = 10), placebo (n = 10), or vedolizumab 300 mg IV (n = 2). At week 52, 4 out of 10 patients (40%) who received vedolizumab SC had clinical remission versus 2 out of 10 patients (20%) who received placebo (difference: 20% [95% confidence interval, –27.9 to 61.8]). Two patients (2/10, 20%) who received vedolizumab SC experienced an injection-site reaction versus none who received placebo. Conclusions Our results indicate that the efficacy of vedolizumab SC in a subgroup of Japanese patients with UC are similar with those in the overall VISIBLE 1 study population, and with those established with vedolizumab IV. The safety and tolerability of vedolizumab SC were generally similar to that established for vedolizumab IV. (ClinicalTrials.gov ID NCT02611830; EudraCT 2015-000480-14)

Behçet’s disease (BD) is a multisystem inflammatory disease of unknown origin. Rarely, BD occurs together with myelodysplastic syndrome (MDS). Interestingly, it is speculated that these are not simple coexistence but that the etiology of intestinal BD is at least partly derived from MDS itself. Furthermore, there is a relationship between MDS in patients with intestinal BD and trisomy 8. Immunosuppressive agents alone are insufficient to control MDS-associated BD, and many of these patients die of infection or hemorrhage. Surgery is considered for intestinal BD patients who are unresponsive to medical treatment or those with bowel complications such as perforation or persistent bleeding. We report a case of intestinal BD associated with MDS and trisomy 8. The patient was unresponsive to oral steroids and immunosuppressive treatment; the patient improved by surgical repair of a bowel perforation. Five years after the surgery, the patient is free of recurrence and not on medication. Our experience suggests that surgery may provide an effective therapeutic option for the treatment of MDS-related BD.

OBJECTIVE: Programmed cell death-ligand 1 (PD-L1) is expressed in tumor cells and has been shown to predict clinical outcomes of several types of malignancies. The aim of this study was to investigate the effects of carbon-ion (C-ion) beam irradiation on PD-L1 expression in human uterine cervical adeno/adenosquamous carcinoma (UCAA) cells and clinical samples and to identify the prognostic factors for outcomes after C-ion radiotherapy (CIRT).METHODS: The effects of C-ion irradiation on PD-L1 expression in human UCAA and cervical squamous cell carcinoma cells were examined by flow cytometry. We examined PD-L1 expression in UCAA biopsy specimens from 33 patients before CIRT started (pre-CIRT) and after 12 Gy (relative biological effectiveness [RBE]) irradiation (post-12Gy-C) in 4 fractions of CIRT to investigate the correlation between PD-L1 status and clinical outcomes.RESULTS: The PD-L1 expression was upregulated by C-ion beam in a dose-dependent manner in HeLa and SiHa cells through phosphorylated Chk1. The overall frequencies of pre-CIRT and post-12Gy-C PD-L1 positivity were 45% (15/33) and 67% (22/33), respectively. The post-12Gy-C PD-L1 expression was significantly elevated compared to the pre-CIRT PD-L1 expression. There was no significant relationship between the pre-CIRT PD-L1 status and clinical outcomes, such as local control (LC), progression-free survival (PFS), and overall survival (OS). However, the post-12Gy-C PD-L1 expression had better correlation with PFS, but not with LC and OS.CONCLUSION: CIRT can induce PD-L1 expression in UCAA and we propose that PD-L1 expression after starting CIRT may become as a predictive prognostic marker in CIRT for UCAA.
Antigens, CD274 ; Biopsy ; Carcinoma, Squamous Cell ; Disease-Free Survival ; Flow Cytometry ; Heavy Ion Radiotherapy ; Humans ; Radiotherapy ; Treatment Outcome ; Uterine Cervical Neoplasms

OBJECTIVE: Programmed cell death-ligand 1 (PD-L1) is expressed in tumor cells and has been shown to predict clinical outcomes of several types of malignancies. The aim of this study was to investigate the effects of carbon-ion (C-ion) beam irradiation on PD-L1 expression in human uterine cervical adeno/adenosquamous carcinoma (UCAA) cells and clinical samples and to identify the prognostic factors for outcomes after C-ion radiotherapy (CIRT). METHODS: The effects of C-ion irradiation on PD-L1 expression in human UCAA and cervical squamous cell carcinoma cells were examined by flow cytometry. We examined PD-L1 expression in UCAA biopsy specimens from 33 patients before CIRT started (pre-CIRT) and after 12 Gy (relative biological effectiveness [RBE]) irradiation (post-12Gy-C) in 4 fractions of CIRT to investigate the correlation between PD-L1 status and clinical outcomes. RESULTS: The PD-L1 expression was upregulated by C-ion beam in a dose-dependent manner in HeLa and SiHa cells through phosphorylated Chk1. The overall frequencies of pre-CIRT and post-12Gy-C PD-L1 positivity were 45% (15/33) and 67% (22/33), respectively. The post-12Gy-C PD-L1 expression was significantly elevated compared to the pre-CIRT PD-L1 expression. There was no significant relationship between the pre-CIRT PD-L1 status and clinical outcomes, such as local control (LC), progression-free survival (PFS), and overall survival (OS). However, the post-12Gy-C PD-L1 expression had better correlation with PFS, but not with LC and OS. CONCLUSION CIRT can induce PD-L1 expression in UCAA and we propose that PD-L1 expression after starting CIRT may become as a predictive prognostic marker in CIRT for UCAA.

Objective: The initial and operational costs of telemedicine are major barriers to its adoption. We aimed to investigate and identify the barriers to adopting a telemedicine system in a Japanese rural general hospital without incurring setup and operational costs.Materials and Methods: Our study was conducted between May and August 2018, and included six general practitioners working at a rural general hospital. We extracted data collected from messages (date and time, sender and recipient, and counts and contents of messages) and conducted semi-structured interviews, which were then analyzed using quantitative and qualitative methods.Results: We quantitatively analyzed the total counted of the 179 messages. The total counts recorded for each physician were 56 (A), 20 (B), 3 (C), 74 (D), 5 (E), and 21 (F). The mean monthly counts were 2.17 (May), 8.50 (June), 11.50 (July), and 7.67 (August). Interview data from the six physicians yielded 13 codes that included various points of dissatisfaction acting as barriers to using our system, which we grouped into mental and physical barriers. Mental barriers included suspicion of carrying, feelings of isolation, and loss, whereas physical barriers included portability, user authentication, internet speed, group chat system, notice, search image, typing, chat system, print facility, and limited function.Conclusion: The representative barriers to introducing a telemedicine system at a rural general hospital in Japan without initial and running costs could be classified as feelings of isolation and suspicion of carrying (mental barriers); and notice, portability, and user authentication (physical barriers). Continued investigation in this area is warranted, and solutions to these barriers could improve the shortage of medical staff in the context of declining birth rates and aging populations in Japan.