Currently, Keishi-bukuryo-gan is widely used for overcoming blood stagnation, and is most frequently used for adult women with blood stagnation (Oketsu) presenting the cold and hot flush (rush in the bust and cold in the lower half of the body) such as menopausal disorder. This time, we carried out thermographic tests for two groups: the patients with subjective symptoms of the cold and hot flush (group 1:8 adult women) and patients with subjective symptoms of cold sensation only in the lower limbs (group 2:8 adult women).
In the first group the difference between the surface temperature of the skin of the upper abdomen and that of the lower abdomen was more significant as compared with the second group. We also observed both groups for 60 minutes after administration of Keishi-bukuryo-gan. In the second group the surface temperature of the skin of both upper and lower abdomen decreased. In the first group, however, the skin temperature of the upper abdomen decreased but that of the lower abdomen increased in reverse, and the difference of the temperature between the upper abdomen and lower abdomen was reduced. This means Keishi-bukuryo-gan worked for improving “the cold and hot flush, ” i. e., the imbalance of the endocrine system and autonomic nervous system.
The findings suggest that Keishi-bukuryo-gan treatments for hot flush, which is the increase of the skin temperature caused by telangiectasis of the skin of the upper body, may increase the blood flow in the lower abdomen and improve pelvic congestion, which is one of the conditions of blood stagnation, as well as decreasing the skin temperature by contracting peripheral vessels.

Zentai (Cicadae Periostracum) is classified by traditional Chinese medicine as one of the “pungent cool-natured” drugs, but its pharmacological action is not well known yet.
Zentai is used in Shofu-san as an expelling pathogenic wind component for relieving itchiness for patients with eczema, dermatitis, urticaria, etc.
We examined a number of patients with atopic dermatitis whose condition worsened after they were treated with Zentai to relieve itchiness.
In the current study, five male and ten female adolescent/adult patients were randomly selected to receive 2.5g of Zentai. These patients had been treated with Kagen-ichiin-sen-ka-kiban-kyo and their skin conditions had been stable so far.
In a follow-up two weeks later, the water content of the horny layer of skin at the forehead and the anterior side of the forearm decreased significantly (p<0.05). In terms of the level of itchiness, two patients (13.3%) improved, nine patients (60%) worsened, and the other four (26.7%) remained unchanged.
The current study indicates that Zentai worsens dry skin and exacerbates itchiness. Care will be required in the use of Zentai for the treatment of atopic dermatitis because of its drying pharmacological character.

We examined the rates of sudden death to ordinary deaths of the patients in two hospitals in Obihiro. A total of 130 sudden death cases (89 men and 41 women) out of 1, 088 ordinary deaths were listed (11.9%) during the period of two years from 1992 through 1993.
We also looked into the cause of sudden death in 86 autopsied cases over a 15-year period from 1985 through 1999 from a pathological stand point. Cardiac diseases underlay 49 cases of sudden death. Myocardial infarction (42 cases), cardiomyopathy (2), sarcoidosis (1), amyloidosis (2) and valvular disease (2) were regarded as the causes of death in the 49 cases. Myocardial infarction occurred more frequently in men than in women (27: 15). Next to cardiac diseases came aortic diseases such as ruptured aortic aneurysm (7 cases) and dissecting aneurysm (6). Cardiac diseases (49 cases) and aortic diseases (13) combined to account for 62 of 86 (72.1%) autopsied cases. Among noncardiovascular diseases, respiratory diseases (18 cases) topped the list, followed by alimentary diseases (3) and cerebral bleeding (2). The major cause of respiratory diseases was pulmonary embolism (16). Pulmonary embolism more often occurred in women than in men (14: 2). There was one case of unidentifiable sudden death, namely Pokkuri disease. A decreased incidence of sudden death on Sunday should be noted. A circadian rhythm was evident. The incidence of sudden death started rising from 6: 00 and peaked at 15: 00. Sudden death occurred during rest (42 cases), during routine daily activity (14), during sleep (11), during bathing (1), during defecation (8), during surgery (2), during physical exercise (6) and during agricultural work (2).

　　The purpose of this study was to identify the factors affecting the stair-climbing ability of patients with hip fractures.　　Out of a total of 75 inpatients with hip fractures, 14 disabled elderly patients, whose ability to perform independently the basic activities of daily living was assessed as rank B or C before injury, and 10 demented elderly patients, whose ability was rank II, III, IV or M, were excluded. The remaining 51 patients were selected for the present study. The subjects were divided into two groups: 19 patients who were able to ascend and descend the stairs (the riser height: 20cm) by holding the handrails and 15 patients who could not.. In another experiment, the 51 subjects were divided into two groups: 19 patients who were able to go up and down the stairs without the aid of the handrails and 32 patients could not. Age, gender, height, weight, fracture type, number of postoperative days, hip abductor strength, knee extensor strength, level of pain, leg length discrepancy, tandem stance time, and stair-climbing ability were investigated.　　First, the correlation between the parameters and stair-climbing ability was verified using a univariate analysis. Subsequently, a multiple logistic regression analysis was performed using the parameters that represent a significant correlation with the stair-climbing ability as the dependent variable.　　These analyses revealed that “non-fractured knee extensor strength” was significantly associated with the stair-climbing ability when the subjects were allowed to use the handrails, while “non-fractured knee extensor strength” and “tandem stance time” were significantly associated with the stair-climbing ability without the aid of the handrails.　　These findings suggested that the improvement of non-fractured knee extensor strength was important for the acquisition of stair-climbing ability with the aid of the handrails and the improvement of static balance as well as non-fractured knee extensor strength was important for the acquisition of stair-climbing ability without the aid of the handrails.

　　This study sought to identify whether the inter-rater reliability of lower limb muscle strength measurements made using a hand-held dynamometer differs for patients with hip fracture according to the severity of their cognitive impairment. Of the 144 patients with hip fracture hospitalized at our institution, we excluded 28 from this study (18 with level III, IV, or M of independence in daily living for the demented elderly, 8 with a history of central nervous system disorders, and 2 who were transferred to another department), leaving 116 patients for analysis. These 116 patients were divided into three groups according to their severity of cognitive impairment: 44 with a normal level of independence in daily living for the demented elderly, 38 with level I independence, and 34 with level II independence. We compared the intra-class correlation coefficients and the standard error of measurement between the groups. There were no significant differences in the intra-class correlation coefficients between the groups. The standard error of measurement in the group with level II independence in daily living for the demented elderly was significantly lower than that in the other two groups. These findings indicate that the inter-rater reliability of lower limb muscle strength measurements using a hand-held dynamometer in patients with hip fracture did not differ between patients with mild or moderate cognitive impairment. Furthermore, the inter-rater reliability was high.

Objective: We investigated the relation between fasting insulin (FI) and risk of cerebral infarction in a Japanese general population. Methods: The subjects were 2,610 men and women without past history of stroke or myocardial infarction and under treatment for diabetes, examined between 1992 and 1995 as part of the Jichi Medical School Cohort Study. The FI level was measured once at the baseline. Subjects were divided into quintiles by FI levels, and Cox’s proportional hazard model was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for cerebral infarction. Results: During an average of 11.1 years of follow-up, 87 participants developed cerebral infarction. Crude incidence rates of FI quintiles 1-5 were 4.69, 2.35, 1.85, 2.77 and 3.30 per 1,000 person-years, respectively. The multivariate-adjusted HRs for cerebral infarction were 2.33 (95% CI, 1.10 – 4.96) in quintile 1 (Q1), 1.25 (95% CI, 0.55 – 2.84) in Q2, 1.68 (95% CI, 0.76 – 3.70) in Q4 and 2.06 (95% CI, 0.94 – 4.47) in Q5, using Q3 as the reference. Conclusions: The lowest FI level was associated with increased risk of cerebral infarction and the association between FI and risk of cerebral infarction appeared to be a U-shaped relationship.

Methods: HFCs were obtained from patients with LSS who underwent surgery. HFCs were stimulated by tumor necrosis factor-α (TNF-α) and a p38 MAP kinase inhibitor, SB203580. Phosphorylation of the p38 MAP kinase was analyzed by western blotting. The concentration of interleukin-6 (IL-6) in the conditioned medium was measured by enzyme-linked immunoassay and IL-6 messenger RNA expression levels were determined by real-time polymerase chain reaction. Results: TNF-α induced the phosphorylation of p38 MAP kinase in a time-dependent manner, which was suppressed by the p38 MAP kinase inhibitor, SB203580. TNF-α also stimulated IL-6 release in both a time- and dose-dependent manner. On its own, SB203580 did not stimulate IL-6 secretion from HFCs; however, it dramatically suppressed the degree of IL-6 release stimulated by TNF-α from HFCs. Conclusions This is the first report suggesting that TNF-α stimulates the gene expression and protein secretion of IL-6 via p38 MAP kinase in HFCs. A noted association between tissue hypertrophy and inflammation suggests that the p38 MAP kinase inflammatory pathway may be a therapeutic molecular target for LSS.

Objective: The “One-half Rule” for OTC drug sales has been eliminated, and furthermore, “Remote-controlled sales” of OTC medicines by qualified sellers is under discussion. The number of registered sales clerks is greater than the number of pharmacists selling OTC drugs. Although this is a result of the different employment status of pharmacists and registered sales clerks due to their salary structure and role in the store, it can be said that registered sales clerks are the main people to deal with the general public when they purchase OTC drugs. Therefore, we conducted a survey of registered sales clerks in order to understand their actual work and their awareness of the revision of the system, and to estimate the impact on customers and patients.Methods: The questionnaire was administered at an external training session held by the Tokyo Metropolitan Druggist Association from April 16 to 18, 2022.Results: Valid responses were obtained from 319 participants. Responses were obtained for the ratio of work as a registered sales clerk before becoming a qualified, after qualification (present), and what they think would be an ideal work ratio. The percentage of “pharmaceutical consultation and sales” increased from 7.7 to 15.9, and finally 26.4% before, at present, and ideally, respectively. It was clear that the acquisition of the certification increased the percentage of specialized tasks and that the respondents would like to further increase this percentage. Awareness of the “One-half Rule” and “Remote-controlled sales” was 43.6 and 23.8%, respectively.Conclusion: It was inferred that the introduction of “Remote-controlled sales” would improve convenience but dilute interpersonal work, which would hinder the operation, maintenance, and management of the store, including courteous customer service that cannot be handled through a screen. Therefore, from this study, we believe that registered sales clerks express doubt about the introduction of “Remote-controlled sales”.

BACKGROUND: Studies on the adverse effects of Asian dust (AD) on respiratory function in children are scarce. The objective of this study was to examine the association between AD and respiratory function by measuring peak expiratory flow rates (PEFRs) in asthmatic children. METHODS: The study was carried out from March to May from 2014 through 2016. One hundred ten children with bronchial asthma were recruited from four hospitals in the Goto Islands and south Nagasaki area in Nagasaki prefecture. The parents were asked to record their children's PEFRs every morning/evening and clinical symptoms in an asthma diary. AD was assessed from light detection and ranging data, and a linear mixed-effects model was used to estimate the effects of AD on daily PEFR. Time-stratified case-crossover analyses were performed to examine the association between AD and asthma attacks defined by reduction levels in PEFR. RESULTS: AD was detected on 11 days in the Goto Islands, and on 23 days in the south Nagasaki area. After adjusting for age, sex, temperature, and daily oxidants, we found a consistent association between AD and a 1.1% to 1.7% decrease in PEFR in the mornings and a 0.7% to 1.3% decrease in the evenings at a lag of 0 to 5 days. AD was not associated with the number of asthma attacks, respiratory symptoms, or other symptoms at any lag days examined. CONCLUSIONS Exposure to AD was associated with reduced PEFR, although the effects were not large enough to induce clinically apparent symptoms, in clinically well-controlled asthmatic children.