From the clinical point of view of the acupuncturist 105 cases of sciatica were classified according to Interview Impressions (age, sex, affected limb, degree of pain in local areas, motor pain in lumbar vertebrae); Observation Impressions (structural disorders of lumbar vertebrae); Palpation Impressions (tenderness, sensitivity disorders); Special Test Information (SLR, Bonnet Test, ATR, PTR, muscular strength disorders, etc.); and the original disease assumed.
It was possible to assume the original disease in a high percentage -68%- that is 71 of 105 cases. Spondylosis deformans occurred in patients middle aged or over and was characterized by pain upon walking, spinous process irregularities, etc., Lumbar hernia occurred in young patients and was characterized by remarkable SLR results, tenderness between the spinous processes, etc., Slipped disc was characterized by deformation of lumbar disc arrangement, ATR disturbances, palpation disturbances, etc., Spinal canal stenosis was characterized by intermittent claudication, pain relief with anterior bending of the lumbar spine, sensory disturbance in the lower limbs, etc. In piriformis muscle syndrome cases Bonnet Test results were positive, SLR light and ATR normal.

Good Death Scale (GDS) is a provider assessment scale of quality of dying of terminally ill cancer patients, and its reliability and validity has been confirmed. The aim of this study is translating the GDS into Japanese (GDS-J) according to the standard methods of conducting linguistic validation. In the forward translation, there was a disagreement in the translation of “will” into Japanese translation of “will” of GDS question 3 “Has the patient arranged everything according to his/her own will?” We confirmed linguistic validity in the research team and eventually got approval from the original author in writing and decided on GDS-J. Using the GDS-J, a quality assessment scale for palliative care by provider, it will be possible to evaluate the quality of palliative care to be done by themselves and to be expected to be useful for providing higher-quality palliative care.

Using 69 patients afflicted with arthralgia of the shoulder joint accompanied by motor limitations as subjects we conducted research to determine to what extent the nature of the shoulder arthralgia could be assumed based upon clinical observations centered around interview and palpation tests.
Our method was to determine guide symptoms for various shoulder joint diseases and make assumptions as to the origin of the patient's condition based on the rate of occurrence of these symptoms.
Results revealed 34 (49%) cases of adherent inflammation of the articular capsule, 12 cases of inflammation of the synovial bursa of the acromion and 9 cases of tendonitis of the long head of the biceps brachii muscle. In addition cases of tendinitis of the rotator cuff tendonits of the supraspinatus muscle and inflammation of the coracoidal process were assumed. In some cases there was pain in the posterior area of the shoulder and tenderness was observed in the tendon of the triceps brachii muscle in 5 cases. It was shown that assumptioons such as these based upon clinical observation are to some extent helpful in diagnosis.

Making external reference observations the object of our study, we attempted to assume the root disease in 60 subjects afflicted with cervical brachialgia.
Results showed 3 cases of cervical-spinal disease symptoms assumed from sensory disturbances of the upper and lower extremities or gait disturbances, etc.; 27 cases of cervical nerve root symptoms determined by the Spurling Test and pain and tenderness with backward flexion of the cervical vertebrae; 18 cases of thoracic outlet syndrome determined through the Wright Test, and Morley Test, etc. 5 cases of cervico-scapulo-brachial syndrome did not show the above mentioned disease conditions and 7 cases were undetermined.
The above was not conclusive diagnosis but it did help in assuming an outline of the disease conditions. From the point of view of therapeutic results it was observed that acupuncture therapy was not appropriate for spinal symptoms, appropriate to a degree for nerve root symptoms and appropriate for thoracic outlet syndrome.

　　Persons who are abused often have serious problems in a complicated life situation. We studied this issue and considered ways in which medical social workers (MSWs) handle these social problems. We collected data in 16 cases of elderly abuse that were managed by staff at our hospital from 2010 to 2013 and compared the characteristics in these cases with those of 23 cases of child abuse during the same period. Data analysis revealed 3 characteristics of abused persons: insufficient use of long-term care insurance service; mental disorder such as dementia or mental illness; and financial problems. Further detailed analysis found that intervention for elderly abuse cases was requested only in more difficult cases when abuse was easily identified by our staff. Therefore, staff’s awareness and motivation to become more involved in cases of elderly abuse may be low compared with cases of child abuse. Hospital staff are in a position where they should be able to readily identify maltreatment of aged persons. We need to develop a mechanism for the early detection of elderly abuse so staff can intervene easily in mild cases of elderly abuse, and ask for assistance from MSWs in more difficult cases. It is important to ensure that all employees have access to MSWs in the hospital.

Although there are a number of reported cases of increased cerebral blood flow during exercise, there are no reports on the relation between changes of blood flow during exercise and attentional function. The purpose of this study is to clarify the relation between changes of blood flow during exercise with AT intensity and attentional function, using near-infrared spectral analysis. The subjects were 10 healthy males. The research protocol was to conduct steady load exercise. We randomly conducted two invention trials: 1) an exercise/task trial in which a trail making test (TMT) was performed as an attentional assignment during steady load exercise, and 2) a rest/task trial in which TMT was performed during rest as a control. As a result, we observed the following: increase of oxy-Hb in the prefrontal cortex during AT exercise, the significant shortening of TMT during exercise from 69.1±10.2 seconds to63.2±7.2seconds, and, with further control, that the more oxy-Hb rises, the more TMT time is shortened. From these results, it is suggested that 10 minutes of exercise would improve attentional function, and furthermore, there is a possibility that increased cerebral blood flow may be involved with the improvement of attentional function.

  After 1985, the decrease in domestic nursing power progressed gradually. The care for the elderly shifted from domestic private nursing to public nursing-care services when the long-term nursing-care insurance law was enacted in 2000. Because many of the elderly receiving nursing care suffer from chronic ailments of hypertension or the consequences of cerebrovascular disease, etc., cooperation between hospitals and nursing homes is necessary and indispensable. We began exchanging information by E-mail on a trial basis with a special elderly nursing home in April 2009. We aimed to integrate medical care and nursing by sharing medical and nursing information. We concluded that the use of E-mail could serve our purpose. The reason why we reached this conclusion is as follows:The mechanism of the information transmission by E-mail, that also relates to semiotics and narratology, is related to the essence of the description. This mechanism functions as a tool for mutual understanding among hospitals, nursing homes, and families. This also functions as a device to make the medical and nursing experience join. As a result, this mechanism enables the elderly to escape death as dying of sickness in the hospital and to die a natural death in the course of nursing. It is an easy method that can be introduced at a low cost for the purpose of establishing cooperation in medical and nursing care among hospitals, clinics, nursing homes, and nursing support centers, etc. especially in medically underserved remote areas.

The promotion of fatty acid metabolism, to which PPARα contributes, has been suggested that it would be participate to maintain the proximal tubular cell function in kidney. The loading on the proximal tubular cell of fatty acids could arise the inflammation and cell death in obesity. One of the “Kampo” medicines, Boiogito (BO) is used for the remedy of overweight women exhibiting chronic fatigues as well as edema in the lower extremities or knees. BO would exhibit the prevention of the proximal tubular cell damage and improvement of kidney function by reducing the portion of fatty acids. In this study, BO was orally administered high fatty acid combined with bovine serum albumin for mice to evaluate the mRNA expression of PPARα quantified by PCR. The increase of PPARα mRNA expression was observed BO administration, followed by reduce the volume of fatty acids in kidney.KEY WORDS: Boiogito, Fatty acid metabolism, PPARα, Proximal Tubular CellINTRODUCTIONObesity is a risk factor for incidence of albuminuria and chronic kidney disease 1, 2, and an accumulating visceral fat would be involved in the regulation of primary stage of nephropathy 3, microalbuminuria. Fatty acids are major contributor to these kidney disorders caused by obesity 4. The binding fatty acids with albumin represents in blood generally, taking up by proximal tubular cells after glomerular filtration from albumin. A peroxisome proliferator - activated receptor (PPARα) has been suggested that it would regulate the fatty acid metabolism. Because the glomerular filtration rate and renal blood flow would increase in overweight patients 5, a large quantity of free fatty acids should be loaded into proximal tubular cells. Therefore, the investigation concerning to PPARα stimulator can be regarded as the fatty acid metabolism - regulation. One of the “Kampo” medicines, Boiogito (BO) is used for the remedy of the inflammation and cell death in obesity, is composed of eight crude drugs: Aluminum Silicate Hydrate with Silicon Dioxide, Astragalus Root, Atractylodes Rhizome, Ginger, Glycyrrhiza, Jujube, Sinomenium Stem and Rhizome. In this study, to clarify the therapeutic mechanisms of BO, we focused on the up - regulating for fatty acid metabolism through the PPARα activation.METHODSKampo formulaeBO was prepared according to the prescription for a one-day dose 6: 3.0 g Aluminum Silicate Hydrate with Silicon Dioxide, 5.0 g Astragalus Root, 3.0 g Atractylodes Rhizome, 1.0 g Ginger, 2.0 g Glycyrrhiza, 4.0 g Jujube, 4.0 g Sinomeniumstem and Rhizome.

Objective: In this study, we evaluated distinctive types of physical predisposition in patients with common side effects.
Method: We selected 500 and 1,200 individuals with and without a previous diagnosis of side effects, respectively, through web-based research.  Then, we conducted a decision tree analysis for investigating the status of 100 types of physical predisposition in these individuals.
Results and Conclusion: The individuals who had suffered from hepatic disorder and answered “relevant” for “predisposition to swelling” (likelihood ratio of a positive result [LR+] 2.17; p=0.004) and “very relevant” for “predisposition to skin dryness” (LR+ 3.52; p<0.001) enhanced the probability of extracting individuals who developed side effects.  The individuals who had suffered from skin disorder and answered “relevant” for “predisposition to eczema and inflammation” and “not relevant” for “predisposition to higher temperature” had an LR+ of 2.22 (p<0.001).  The individuals with “predisposition to worsening of physical condition on a rainy or high-humidity day” are more likely to develop side effects with the use of antibiotics and NSAIDs, compared to those without this predisposition (antibiotics: LR+ 2.33; NSAIDs: LR+ 2.51).  The results of this study indicate that we can identify patients with a high risk of side effects through an interview on predisposition.

A recurrent laryngeal nerve injury is known as a complication referring to an anterior cervical spine surgery. However, hypoglossal nerve injury is not well known yet. Herein we report a rare case of a 39-years-old male with a hypoglossal nerve injury after C3/4 osteophyte resection with Smith-Robinson approach. In this case there appeared difficulties of articulation and tongue movement with deviation of the tongue to the left side after the surgery and we diagnosed a hypoglossal nerve injury due to retraction against the nerve during the operation. During the operative approach to the upper cervical spine we had to retract the internal carotid artery and the soft tissue to reach the vertebrae. This retract was the cause of the hypoglossal nerve injury. A gently traction and intermittent release is important to avoid a hypoglossal nerve damage.
Carotid Artery, Internal ; Cervical Vertebrae ; Female ; Humans ; Hypoglossal Nerve ; Hypoglossal Nerve Diseases* ; Hypoglossal Nerve Injuries ; Male ; Osteophyte ; Recurrent Laryngeal Nerve Injuries ; Spine* ; Tongue ; Traction