The purpose of this study was to determine if Moxibustion stimulus influence on the circulation in the sacral area.
In the first phase of this study, the influence of indirect Moxibustion stimulus (using‹SEN-NEN-KYU›) on the amount of blood flowing to the sacrum was investigated using laser Doppler Perfusion Imager PeriScan PIM II.
Significant increase in the amount of blood flow in radial directions were observed around the area where Moxibustion was applied. Immediately after the stimulus, significant differences in the amount of blood flow were observed within 2.5cm to the right and left and 1.5cm above and below the stimulated spot.
With increasing time after the Moxibustion stimulus, the amount of blood flow gradually decreased concentrically returning to the original state over time. However, the amount of blood flow at the Moxibustion spot was significantly higher than the original state 32 minutes and 52 seconds after the Moxibustion treatment.
Increased blood flows to pressure ulcers area induced by Moxibustion stimulus are considered to restrict or arrest the progress of pressure ulcers (according to Stage I of the International Association for Enterostomal Therapy (IAET) classification) on in-home care.

BACKGROUND : Norm-referenced equations to predict the 6-minute walk distance (6MWD) in healthy Japanese subjects have not been established. The current study aimed to determine the reference values for 6MWD in healthy Japanese adults.
METHODS : Ninety-seven healthy Japanese men and women aged 40-79 years were recruited from Kyoto city using posters and flyers. Measurements of 6MWD were performed twice on an indoor 30 m track with 20 minutes rest between the two tests. Before performing the tests, age, gender, height, body weight, waist circumference, a questionnaire for health status, spirometry, and a 12-lead electrocardiogram were recorded. The 6MWD was measured following guidelines published in 2002 by the American Thoracic Society.
RESULTS : The mean age of the study subjects was 57.0±9.4, and 63 of the 97 subjects were female. The mean 6MWD for all subjects was 672±83 m, with a range of 483-903 m. The 6MWD is significantly correlated with age, height, waist circumference, forced vital capacity (FVC), and forced expiratory volume in one second (FEV₁). A multiple linear model showed age, waist circumference, and FVC were significantly associated with 6MWD and the model explained 35% of the variability in 6MWD. When FVC was replaced by height, the regression model also explained 32% of the variation. The measured 6MWD of Japanese subjects was similar to the predicted 6MWD using the equations derived from Caucasian subjects.
CONCLUSIONS : The 6MWD was affected to a substantial degree by age, waist circumference, height, and FVC in healthy Japanese adults.

During a period of 5 years from January 1991 to December 1995, one-stage operation was performed on 10 cases with ischemic heart and occlusive peripheral vascular disease, excluding cases combined with AAA (abdominal aortic aneurysm). They were composed of 7 men and 3 women whose mean age at time of surgery was 65.8 years. The mean number of coronary artery bypass grafts made was 2.2. The procedures employed for occlusive peripheral vascular disease were TEA (thromboendarterectomy) of the internal carotid artery in 2 cases, aorta-subclavian bypass in 2 cases, aorta-bilateral common iliac artery bypass in 1 case, interposition of the common iliac artery in 1 case, aorta-external iliac artery bypass in 1 case, F-P (femolo-popliteal) bypass in 3 cases (4 bypasses), and F-T (femolo-tibial) bypass in 1 case. Mean operation time was 428 minutes, mean extracorporeal circulation time was 121 minutes, and mean aortic cross-clamp time was 61 minutes. Blood transfusion was not made in 4 cases. There was one operative death in a case of MNMS (myonephropatic metabolic syndrome) with emergency IABP (intraaortic balloon pumping) insertion following complication of PMI (perioperative myocardial infarction). A comparative study was made with 183 non-emergency cases of CABG (coronary artery bypass graft) conducted during the same period. Operation time was longer in cases of one-stage operation, but no significant difference was observed in operative mortality rate, rate of cases not requiring blood transfusion, days of intubation, and postoperative hospitalization duration. The surgical procedure was relatively safe.

Objective: In The Hospital of Hyogo College of Medicine, a oral rinse containing polaprezinc (PZ), a zinc-containing drug for gastric ulcers, was used as a hospital preparation to treat radiotherapy-related oral mucositis, and its efficacy was reported.  However, the dispersibility of PZ for carboxymethylcellulose sodium (CMC), which was used as the base of the oral rinse, was unfavorable, raising an issue.  In this study, we newly prepared a PZ oral rinse containing carboxyvinyl polymer (CP) as a base, and examined its usefulness.
Methods: A questionnaire survey regarding the usefulness involving 10 healthy volunteers and a pharmaceutical test were conducted.
Results: The results of the questionnaire survey showed that the optimal concentration of CP was 0.5%.  There were no serial changes in the pH, adhesiveness, or PZ content for 7 days after preparation.  Furthermore, there were no differences between CMC and CP.  The dispersibility of PZ in the oral rinse containing CP as a base was more favorable than that in the oral rinse containing CMC.
Conclusion: The results of this study suggest that the PZ oral rinse containing 0.5% CP as a base is useful, and that its stability is similar to that of the oral rinse containing CMC as a base.

Objective: Oral mucositis is one of the serious and frequent acute side effects due to chemoradiotherapy (CRT) for head and neck cancer.  In this study, we prepared an oral rinse as a hospital preparation for the treatment of oral mucositis, which was a suspension of polaprezinc (PZ), a zinc-containing therapeutic agent for gastric ulcer, in carboxyvinyl polymer (CP), a water-soluble large molecule.
Methods: We carried out stability tests of the PZ-CP oral rinse, and investigated its effects on the radiation-induced oral mucositis in patients who received CRT for head and neck cancer.
Results: In the stability test, the pH, viscosity, adhesion and PZ content in the preparations did not change throughout 28 days after preparation.  In the clinical evaluation on the basis of the distribution of the Grade of oral mucositis, the Grade of oral mucositis in the PZ group was significantly lower than in the control group at 6 and 7 weeks (p=0.016, p=0.018).  The incidence of severe oral mucositis of Grade 3 was 15.0% (3 cases) in the PZ group and 41.7% (10 cases) in the control group at 6 weeks, and was 15.0% (3 cases) in the PZ group and 33.3% (8 cases) in the control group at 7 weeks.
Conclusion: These results suggest that PZ-CP oral rinse inhibits the aggravation of oral mucositis induced by CRT or promotes its healing.

Objective: This study aimed to investigate the effect of nutritional status on estimated fentanyl absorption in cancer patients being treated with a fentanyl transdermal patch (FP), by measuring the residual fentanyl content in used patches. Methods: 24 adult Japanese inpatients receiving FP treatment for chronic cancer-related pain were enrolled. During FP application, the nutritional risk of the patients was measured using the Malnutrition Universal Screening Tool (MUST) and Nutritional Risk Screening 2002 (NRS 2002), both of which are nutrition screening tools used widely in Japan. We then classified the patients into low-, medium-, and high-risk groups according to the nutritional risk measured by MUST, and compared the transdermal fentanyl delivery efficiency (FE) between that groups. Results: The FE, which is estimated by the residual fentanyl content in used FPs collected from the patients, was found to be decreased in the high-risk group. According to NRS 2002, the mean transdermal fentanyl delivery efficiency in the high-risk group was significantly lower than that in the low-risk group. Conclusion: These results showed that changes in nutritional status affect FE, and that poor nutritional status might decrease transdermal fentanyl absorption in cancer patients.

Objective: The Hyogo Hospital Pharmaceutical Society has been conducting an original pharmacy postgraduate education program, “lifelong learning program (to nurture pharmacy specialists)”, since 2002 using the Internet.  To understand the status of using this program, this study employed a questionnaire survey involving all registered members.
Methods: Subjects were all members (1,870) of the society.  Questionnaires were distributed and collected by mail.
Results: Only 20.1% of the members had experience of using the program, and the frequency of using it was less than once per 6-12 months in 60% of the members.  Their level of awareness concerning the acquisition of credits for lifelong learning was 36.9%.  The program category they wished to take was an infection-related program in 26.1% of the members, which was the highest.
Conclusion: As reasons for only a small number of members using the program, the following are considered: loss of user’s ID and password required to login, and lack of awareness concerning the acquisition of credits for lifelong learning offered by the Japanese Society of Hospital Pharmacists.  As future issues, we must encourage members to obtain a new password and be proactively involved in preparing new program categories that the members wish to take, in order to promote the continuous use of the program.

It has been five years since TC 249 was established as a new Technical Committee (TC) at the International Organization for Standardization (ISO), specializing in the field of Chinese traditional medicine. In the second Plenary Meeting held in Den Haag (2011), five working groups (WGs) were established within the TC, two of which specialize in standard development of acupuncture needles (WG3) and other medical devices used in traditional medicine (WG4). Japanese delegates have participated in the discussion within these WGs, paying close attention so as to keep the proposals under discussion consistent with existing Japanese standards and certification standards regulated by the Ministry of Health, Labour and Welfare. However, since most of the participants in TC 249 are clinicians or researchers engaged in medical practices, and not experts on domestic/international standards, discussions on harmonization of the submitted projects often become complicated. In this manuscript, four experts (two from academia and two from companies that manufacture acupuncture needles and moxibustion devices) who attended the fourth plenary meeting held in Durban, South Africa, in May 2013, report on the stage of progress of standardization development in WG3and WG4.

Background: Complementary medicine and alternative medicine have been included in the curricula of many medical schools and colleges; however, teaching methods have not been standardized. We gave lectures and practical instruction on acupuncture and moxibustion medicine to medical students during their clinical clerkship in anesthesiology. We used a questionnaire to evaluate the usefulness of small-group teaching.
Methods: The subjects were 93 fifth-year medical students doing clinical clerkships in anesthesiology. The clinical clerkship consists of small-group learning with 2 or 3 students per group. After a lecture and practical instruction on acupuncture and moxibustion were given, students were asked to fill out a questionnaire about their interest in and basic knowledge of acupuncture and moxibustion and whether they would like to master the technique.
Results: All 93 students answered the questionnaire （response rate, 100%）. After the small-group teaching, students became more interested in acupuncture and moxibustion and learned that the costs of treatment were covered by health insurance. Most students were interested mastering acupuncture and moxibustion in the future.
Discussion: Our results suggest that lectures and practical instruction during clinical clerkship are useful for getting medical students interested in acupuncture and moxibustion medicine.

The location of organs and tissues at the tip of acupuncture needle inserted in acupuncture points was studied on the human transverse sections.
A female, japanese, cadaver (139cm long, and 52kg in weight) was fixed with an aldehyde mixture and frozen for 3 weeks at -30°C. Then the cadaver was cut into blocks along the transverse planes perpendicular to the median plane at each point of Bladder meridian.
This report describes the depth of organs and tissues in 5 transverse planes from DAITSUI (Governor vessel meridian) to KETSUINYU (Bladder meridian).
At DAITSUI, acupuncture needle penetrates through 7.5mm thick skin, 28.5mm thick hypodermis, and reaches to the transverse process of the 7th cervical vertebra at 36mm away from the surface. At DAIJO, the needle penetrates through the skin, hypodermis, trapezius, rhomboideus, and deep back muscles of 6, 8, 5.5, 10 and 14mm in thickness respectively. The needle reaches to the 2nd rib at 43.5mm away from the surface. At FUMON, the needle penetrates through the skin, hypodermis, trapezius rhomboideus, deep back muscles of 7, 5, 3.5, 4 and 18.5mm in thickness respectively. The needle reaches to the 3rd rib at 38mm away from the surface. At HAIYU, the needle penetrates the skin, hypodermis, trapezius, and deep back muscles of 6, 4, 3 and 22mm in thickness respectively, and reaches to the 4th rib at 35mm away from the surface. At KETSUINYU, the needle penetrates the skin, hypodermis, trapezius, and deep back muscles of 5, 3, 4 and 21mm in thickness respectively, and reaches to the 5th rib at 33mm away from the surface.
The depth of acupuncture points studies was discussed from the clinical points of view.