Typically, Japanese Kampo doctors use formulas classified for treating blood stasis, to treat pain. However,there have been few reported cases where pain was treated with formulas classified for treating qi stagnation. Here, we report a case of right lateral epicondylitis in a 48-year-old woman who was treated with a focus on qi stagnation and with uyakujunkisan. She underwent conservative treatment at an orthopedic clinic for ten months, but her pain was not relieved. Hence, she opted for Kampo treatment. She was in a state of melancholy, felt heaviness throughout her body, and had irregular menstruation. These symptoms were mainly related to qi stagnation, and hence, we chose uyakujunkisan without white silkworm, but with aconite root. One month later, the stiffness in her shoulder improved and the pain was reduced. Magnetic resonance imaging taken 2 months later showed an improvement in the lesion. Nine months later, her menstruation became regular, and 11 months later, the pain had almost completely resolved and she could comfortably perform activities of daily living. Uyakujunkisan is introduced in the classical textbooks, and we interpret uyakujunkisan as a formula that can treat pain with qi stagnation. In Kampo treatment, effective pain treatment involves consideration of not only local blood stasis but also general qi stagnation.

This study aimed to assess the effect of short-interval intracortical inhibition (SICI) before a jump off a platform (pre-set) on drop jump (DJ); the purpose was to investigate the relationship between this activity and performance, and the different effects of SICI on agonist and antagonist muscles during pre-set for jump athletes. Jump athletes (Jumper group, n=13) and Other athletes (Other group, n=9) performed DJ from drop heights of 0.30, 0.45, and 0.60 m). DJ performance was evaluated with DJ-index which was calculated from contact time and jump height. SICI was calculated from motor evoked potentials (MEP) recorded using paired-pulse transcranial magnetic stimulation for the medial gastrocnemius (MG) and tibialis anterior (TA) muscles in 7 jump athletes. Significantly higher DJ performance was observed for the Jumper group at all drop heights, and the Jumper group exhibited greater performance for the highest drop height than the Other groups. Significant decreases in SICI for MG were observed for the Jumper groups, and this decrease in inhibition was more prominent for the highest drop height during pre-set. Furthermore, the correlation between SICI for MG and DJ-index was stronger for increased drop heights, and a significantly positive correlation between these variables was observed at a height of 0.60 m. However, the SICI during the pre-set for TA exhibited no significant change under any of the conditions. The results of the present study suggest the importance of selective disinhibition of brain areas associated with the agonistic muscles during pre-set for higher DJ performance.

This article presents harm reduction, which was recently developed in response to the expansion of injection drug use and the HIV/AIDS epidemic. The authors describe the essence of harm reduction, proposing that harm reduction is a pragmatic strategy from a public health perspective to deal with injection drug use. Also, how harm reduction complements the traditional strategies to eradicate illicit drug use based on abstinence (so called, War on Drugs, or Just Say NO) is discussed. By describing key principles of harm reduction, such as low-threshold programs, non-judgmental attitudes, priority of immediate goals, and balancing costs and benefits, the authors introduce major harm reduction programs, which include needle/syringe exchange, outreach, counseling and education, supervised injection sites, and substitution treatment. Substantial evidence demonstrates harm reduction is effective in preventing the spread of HIV. Although international bodies, such as UNAIDS and WHO, advocate harm reduction strategies for the better prevention from the spread of HIV/AIDS, and some countries have adopted national harm reduction policies, United States discourages harm reduction policies in fighting the global HIV/AIDS pandemic. Finally, the authors address the effectiveness of harm reduction from the public health perspectives to deal with AIDS epidemic among injection drug users and the necessity of comprehensive understanding and multifaceted application of harm reduction. They also present the need to rethink Japanese government policies and social programs to meet drug users' health needs.

The aim of this study was to demonstrate a time-series relationship in drop jump (DJ) from a pre-set state with improved performance. Twelve male college athletes performed a DJ from a height of 0.60 m. DJ performance was assessed with a DJ-index (jump height/contact time). Short-interval intracortical inhibition (SICI) was assessed as intracortical inhibitory circuit excitability in a pre-set state, calculated by using paired-pulse transcranial magnetic stimulation for the medial gastrocnemius muscle (MG). The H-reflex of the left MG and the ankle joint torque were calculated in the early phase of take-off. A significant correlation was shown between ⊿SICI during the pre-set state and the DJ index. Thus, we examined the relationships between phases, focusing on time-series relationships throughout the jump period. The results showed a significant correlation between ⊿SICI during the pre-set state and %H-reflex during the early phase of take-off, and peak ankle joint torque during take-off was also significantly correlated with %H-reflex during the early phase of take-off. A significant correlation was also demonstrated between ankle joint torque during take-off and the DJ-index. In conclusion, we observed a time-series relationship between DJ from a pre-set state and improved performance. A decrease of intracortical inhibitory circuit excitability in the pre-set state affects stretch-reflex facilitation during the early phase of take-off; stretch-reflex facilitation results in the development of a large force in the ankle joint during take-off, and this force develops ankle joint torque. These findings may be used to improve jump performance.

Taping is widely used by sports trainers to prevent injury and to protect affected sites post-injury. However, it is not clear whether taping affect the perception of somatosensory stimulation. We sought to clarify the effect of taping on somatosensory stimulation using somatosensory evoked potentials (SEPs). We recorded SEPs following transcutaneous electrical stimulation of the right medial forearm in ten healthy volunteers. SEPs were recorded from 9 electrodes on the scalp under control, elastic-taping and white-taping conditions. Subjects relaxed on a comfortable reclining seat without taping in the control condition, while they were subjected to taping along the muscle of forearm with tension (elastic-taping) and without tension (white-taping) in the taping conditions. Results showed that the peak amplitude of N140 did not differ significantly among the three conditions but the peak amplitude of P250 was significantly lower in the elastic-taping condition than control and white-taping conditions. Elastic-taping with tension along the muscles changes various afferent inputs from muscle spindle or skin, and this may affect the perception of somatosensory stimulation.

Endovascular treatment for chronic aortic dissection in patients with Marfan syndrome is still controversial. A 60-year-old man developed an extended chronic type B dissection involving the aortic arch and thoraco-abdominal aorta with a large entry at the distal aortic arch and patent false lumen. He had undergone David procedure for type A aortic dissection at age 42, and aortic valve replacement for recurrent aortic valve insufficiency at 58, which was complicated with mediastinitis. He also suffered drug-induced interstitial pneumonitis. Considering his complicated surgical history and impaired pulmonary function, conventional graft replacement of thoraco-abdominal aorta was thought to be quite a high risk. Thus, we chose debranch TEVAR with a staged approach. First, debranching and Zone 0 TEVAR with the chimney technique were performed. Then, 4 months later, abdominal debranching and TEVAR was performed. The patient tolerated both procedures well and was discharged home. Two years after last procedure, he is in good condition and computed tomography shows that complete entry closure and false lumen had thrombosed. This strategy may be worthy to be considered even for a patient with Marfan syndrome, in case the patient's condition is unsuitable for conventional surgery.

Objectives: A survey was conducted to investigate the usability and safety of fentanyl sublingual tablets (FST) and to examine problems associated with their proper use.

Methods: Subjects were 18 cancer inpatients who received FST for breakthrough pain in their pharmacological cancer pain management. Changes in the pain score and the occurrence of adverse effects (nausea, vomiting and somnolence) were compared before and after FST administration.

Results: The pain score before FST administration was 6.4±2.4, and this was significantly improved to 3.4±2.8 at 30 min after administration (p<0.01). Somnolence occurred significantly more often 30 min and 2 h after FST administration than immediately before administration (p<0.05). There were no differences in the occurrence of nausea and vomiting before or after FST administration. Nine patients receiving FST therapy developed xerostomia, but there were no significant changes in the pain score or occurrence of adverse effects while they had xerostomia.

Conclusion: It is essential to observe the oral condition to judge whether FST therapy is indicated, and FST should be administered after providing sufficient oral care. The results indicate the possibility of increased occurrence of somnolence as an adverse effect.