Polycystic ovary syndrome (PCOS) occurs in 5 to 8% of females of reproductive age and is one of the leading causes of menstrual abnormalities and infertility. The treatment of PCOS varies, depending on the patient's age and background, particularly on the presence/absence of a desire to have children. In those desiring to have children, clomiphene therapy is the first-line treatment for PCOS. However, the anti-estrogen action of clomiphene may lead to a thinning of the endometrium and decreased cervical mucus production, while some patients show a poor response to the agent. In this study, saireito was administered to clomiphene-resistant PCOS patients, and the ovulation cycle improved in 6. Effective cases of saireito tended to have higher oketsu (blood stagnation) and suitai (water stagnation) statescores before treatment, also serum LH levels and LH/FSH ratios were lower due to the concurrent saireito medication. Furthermore, these effective cases had lower levels of serum testosterone than the non-effective and clomiphene-effective cases. This clinical report suggests the appropriateness of performing this therapy in accordance with sho (oriental patterns or symptoms), before second-line treatments such as gonadotropin therapy or laparoscopic surgery.

We report a clinical case of adhesive ileus that was treated with daikenchuto during pregnancy, and post cesarean section. A 29-year woman, who had undergone a laparotomy for small intestinal volvulus at the age of 15, was referred to our hospital for abdominal distention at11weeks gestation. Her severe abdominal distention led to the intestinal adhesive ileus finding. After treatment with daikenchuto, she had mass diarrhea while the abdominal symptoms disappeared. Afterwards, the prenatal course was uneventful. Spontaneous labor began at 36 weeks gestation. Under the indication of fetal distress, an emergent cesarean section was performed. There was widespread adhesion between the small intestine and abdominal wall. On post operative day 4, nausea and vomiting increased. Daikenchuto was orally administered with the diagnosis of recurrent adhesive ileus. On day 6, flatus and soft stool were passed. On day 9, oral food ingestion was begun. Her post operative course was uneventful beyond this, and she was discharged on day 25. Recently, clinical reports of adhesive ileus during pregnancy have been increasing as average maternal ages rise. Adhesive ileus during pregnancy tends to be critical for mothers and babies, so a surgical procedure is necessary in many cases. This report suggests the usefulness of daikenchuto for adhesive ileus during the perinatal period.
Intestinal Obstruction ; Pregnancy ; Cesarean Section ; Adhesives ; After values

The aim of this study is to retrospectively examine the efficacy of rikkunshito in comparison with shohangekabukuryoto and metoclopramide, administered to patients with hyperemesis gravidarum, using with the emesis index (EI) proposed by Kitagawa, et al. Total EI score for all groups was decreased with the passage of time, although EI in the rikkunshito group at day 7 was significantly lower than that of the other shohangekabukuryoto and metoclopramide groups. All nausea, vomiting and anorexia, scores were significantly lower in the rikkunshito group. These results suggest that rikkunshito is as effective in hyperemesis gravidarum as shohangekabukuryoto and metoclopramide are, and more effective for the gastrointestinal symptoms of nausea and vomiting, anorexia. The group in which rikkunshito was ineffective tended have a higher qi counterflow score, thus treatment modifications with qi circulating medicine would be required in accordance with sho patterns.

  Habitual bathing varies greatly depending on the country and culture, showering style spreads in recent years in accordance with the age. So we investigate the habitual bathing of modern maternity and the effect of perinatal course.   An unidentified questionnaire was distributed toward the 204 puerperal women, who were delivered in Shizuoka Kosei hospital from April in 2011 to February in 2012. Questinaire consists of multiple-choice selection and free writing about the habitual and balneum bathing. By way of the combination between these results and the maternal events, we investigated the relationship of them.   The 204 puerperal women were divided into 99 primipara, 76 unipara and 29 multipara, who underwent the 12 threatened abortion, 35 threatened preterm delivery, 15 preterm delivery, 7 pregnancy induced hypertension (PIH), and 10 weak labor and 26 preterm rupture of the membrane. On the other hand, all the puerperal women had the habitual bathing every day, 38 of puerperal women (35%) had the style of showering every day, 45 of them had the style of bathing from 1 to 3 times a week, and 121 of them had the style of bathing for over 4 times a week. As compared with their distribution, there was the tendency that PIH was increased in the bathing group, otherwise the weak pains was increased in the showering group.   There is a little evidence how the habitual bathing depends on the factor and promotion of bacterial vaginosis, the style of bathing could encourage the cleanliness and maintain the vaginal flora through the puerperal course in this clinical survey.

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: 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.

This study examined the effectiveness of a communication program in undergraduate medical education in improving communication in physicians' clinical practice. The effectiveness of the program was assessed with a mail survey using self-rated questionnaires 9 years later. Ninety participants were follwed up in late 1994; 57.8% of them replied to the questionnaire. Of the respondents, 60% replied that programs concerned with active listening and role-playing had benefits on communicating with patients and families. In addition, 40% of respondents answered that case studies aimed at teaching comprehensive medicine with the team approach was effective in improving communication with co-medical staff. These results suggest that the communication program in undergraduate medical education is effective in improving clinical communication in clinical practice when students are highly motivated.

Background: Although practicing advanced care planning (ACP) has recently been recommended, little is known about physicians’ practice of ACP, and barriers to ACP in Japan. We aimed to clarify the proportion of physicians practicing ACP and explore barriers to ACP. Methods: We conducted a cross-sectional survey among physicians at a tertiary hospital (934 beds) in 2019, and asked them about their practice and awareness of ACP as well as beliefs regarding end-of-life discussions. A multivariate logistic regression analysis was conducted to explore barriers to their practice of ACP. Results: In total, 90 of 186 physicians responded (response rate, 48%). Forty-two (46%; 95% confidence interval=37-57%) reported that they practiced ACP. In multivariate analysis, determinants of “not” practicing ACP included the lack of awareness of ACP and physicians’ greater beliefs regarding the lack of resources as well as the lack of time and perception of burden. Conclusion: Even at the tertiary hospital, only less than a half of physicians practiced ACP, and the lack of their awareness of ACP and various beliefs served as barriers to their practice. Initiatives to raise awareness of ACP and optimize the management to ensure sufficient time and resources for physicians may be promising to promote ACP.

Objective: The aim of this study was to establish criteria that would indicate whether fertility preservation therapy would likely be safe for patients aged 40 years or less with endometrioid endometrial cancer based on their DNA methylation profile. Methods: Forty-nine fresh-frozen tissue samples from patients with endometrial cancer from an initial cohort and 31 formalin-fixed paraffin-embedded tissue samples from a second cohort were subjected to genome-wide DNA methylation analysis using the Infinium MethylationEPIC BeadChip. Results: Epigenomic clustering of early-onset endometrial cancer was correlated with the widely used recurrence risk classification. Genes showing differences in DNA methylation levels between the low-recurrence-risk category and intermediate- and high-risk categories were accumulated in pathways related to fibroblast growth factor and nuclear factor-κB signaling. DNA hypomethylation and overexpression of ZBTB38 were frequently observed in the low-risk category. Eight hundred thirty-one marker CpG probes showed area under the curve values of >0.7 on the receiver operating characteristic curve for discrimination of patients belonging to the low-risk category. By combining marker CpG sites, seven panels for placing patients into the low-risk category with 91.3% or more sensitivity and specificity in both the initial and second cohorts were established. Conclusions DNA methylation diagnostics criteria using up to 6 of 8 CpG sites for LPP, FOXO1, RNF4, EXOC6B, CCPG1, RREB1 and ZBTB38 may be applicable to recurrence risk estimation for patients aged 40 years or less with endometrial cancer, regardless of tumor cell content, even if formalin-fixed paraffin-embedded biopsy or curettage materials are used.