Objective: Several evidence-based practice guidelines have been developed to better treat bipolar disorder. However, the articles cited in these guidelines were based on clinical or basic studies with specific conditional settings and were not sufficiently based on real-world clinical practice. In particular, there was little information on the doses of mood stabilizers. Methods: The MUlticenter treatment SUrvey on BIpolar disorder in Japanese psychiatric clinics (MUSUBI) is a study conducted to accumulate evidence on the real-world practical treatment of bipolar disorder. The questionnaire included patient characteristics such as comorbidities, mental status, treatment period, Global Assessment of Functioning (GAF) score, and details of pharmacological treatment. Results: Most patients received mood stabilizers such as lithium (n = 1,317), valproic acid (n = 808), carbamazepine (n = 136), and lamotrigine (n = 665). The dose of lithium was correlated with age, body weight, number of episodes, depression and GAF. The dose of valproic acid was correlated with body weight, number of episodes, presence of a rapid cycle and GAF. The dose of carbamazepine was correlated with age, mania, and the presence of a rapid cycle. The dose of lamotrigine was correlated with the number of episodes, depression, mania, psychotic features, and the presence of a rapid cycle. Doses of coadministered mood stabilizers were significantly correlated, except for the combination of valproic acid and lamotrigine. Conclusion The dose of mood stabilizers was selectively administered based on several factors, such as age, body composition, current mood status and functioning. Further prospective studies are required to confirm these findings.

Background: Hot spring inhalation and rock bathing are widely practiced in Europe, and immersion in water up to the shoulders is popular in Japanese balneotherapy. We designed a combination therapy of steam rock bathing and immersion in an open-air hot spring pool for allergic rhinitis.Methods: Data were obtained by anonymous questionnaires from 19 participants with perennial allergic rhinitis who underwent the combination therapy for several days during the spring-pollen season. The participants immersed themselves in a sitting position in Saiboku hot spring water (sodium salt hot spring) at 41°C up to the shoulder level for 10 min in the open-air and then lay on a floor paved with small rocks in a supine position for 20 min in a room filled with the steam from hot springs, then immersed themselves again in the hot spring water for 10 min, and finally rested and sat on a chair for 20 min in a comfortable room. The hot spring water circulated through tubes with small holes that were embedded under the floor, which was paved with small rocks consisting of tourmaline and lime stones. Steam from the hot spring water penetrated through the floor and vaporized in the room. The rock bathing room was 40°C in temperature and 75% in humidity.Results: Clinical symptoms were alleviated in 17 of 19 participants. Watery rhinorrhea, eye itching, sneeze, and sore throat were improved in 100%, 75%, 40%, and 100% of the participants, respectively, compared with symptoms during the previous several years. No adverse effects were observed in any participants. Conclusion: Steam rock bathing, combined with immersion in an open-air hot spring pool, is useful in ameliorating the focal and systemic symptoms of allergic rhinitis.

　　Evaluation of the attitude of patients according to behavior modification stage when they were admitted to hospital for our diabetes educational program and various parameters after they discharged were reviewed.　　We examined the 106 people (53 males and 53 females, average age 66.0 years) who were admitted to our hospital for diabetes education during the period from October 2009 to February 2012. We examined HbA1c levels and measurements taken during the stay in hospital, and 1 month, 3 months, 6 months, 9 months, and 12 months after leaving hospital. Compared with the measured values in the hospital, HbA1c levels measured each month showed a significant improvement (p<0.05). By evaluation of the value according to behavior modification stage, we recognized a rebound tendency in precontemplation groups. The evaluation of patients’ attitude by occupation according to stage of behavior modification revealed a difference more than 2 stages by approximately 10%. From these result, it was speculated that the patient self-management skills made a significant impact on glycemic control after hospital discharge.　　Diabetes educational hospitalization is supported by team members who vary in specialty. It is expected that we can provide higher-quality medical care by each specialist and supporter with a good knowledge.　　Assessment difference of behavior modification stage may appears by each specialty staff member and by changes in physical condition and feeling of the patients. In addition, these causes may change further by difference in the way each specialist deals with the patients. Therefore, we considered it was important to share information and have the mutual confirmation of the evaluation. Now, team medical care is regarded as important. It was suggested that cooperation among the staff members would lead to better medical treatment, and to improvement in patients’ QOL.

We investigated the effect of season or meteorological phenomena, on chief complaints and disorders of outpatients, by way of clarification of relationship between weather and health. This study covered the new outpatients of our division, and carried out on February '03 and June '03 (February: 72 males, 106 females, aged 49.9±18.5, June: 98 males, 109 females, aged 47.6±19.5). We categorized their clinical data into chief complaints (pain, headache, discomforts, fever, cough, vertigo/stagger, palsy) and disorders (gastrointestinal, mental, inflammatory, orthopedic, infection, respiratory, circulatory, tumorous, urinary, autoimmune/allergic, dental/oral, gynecological), then, compared the clinical data of February with June, in terms of seasonal disease. Additionally, we investigated the relationship between weather data and clinical data of February and June, from a perspective of meteoropathy. The average of meteorological phenomena (air pressure, air temperature, relative humidity, velocity of wind, day length, rainfall level) of a week before first visit, were used as weather data. The main results of analysis about seasonal disease, showed that the complaint of discomfort were more frequent in June than February (p=0.005). The orthopedic disorder was more frequent in June than February (p=0.012). Infection was more frequent in February than June (p=0.011). The analyses in terms of meteoropathy, showed that the complaint of cough were more frequent after cold temperature in February (p=0.014). The gastrointestinal disorders were more frequent after humid (p=0.018) and pluvious days (p=0.016) in February. The complaint of headache was liable to be frequent after pluvious weather in June.
The relationship between weather and health is known in the prior an, and our study anew demonstrated the effect of season or meteorological phenomena, on chief complaints and disorders of outpatients, as statistical evidence.

This study aimed at defining the anti-allergic effects of Acanthopanax senticosus Root Extract (EUE) and Perilla frutescens Seed Extract (OSE) used alone or in combination, with the following results. (1) In the histamine release test, histamine release was significantly lower in both EUE and OSE groups than in the control group (p<0.01). EUE combined with OSE at 5:1 also showed a stronger inhibitory effect against histamine release than when used separately. (2) In the PCA test, oral administration of EUE for 14 days either alone or in combination with OSE resulted in dose-dependent inhibition of pigment leak as compared with the control group (p<0.01). In addition, although the beneficial effect of EUE combined with OSE was no greater than that obtained by EUE alone, it was definitely greater than by DSCG (Intarl inhalant solution). (3) An investigation of the effect of EUE against pigment leak induced by histamine and serotonin showed a dose-dependent inhibitory tendency (not statistically significant). In conclusion, EUE and OSE might have anti-allergic effects.

This study investigated the existence of platelet activation before the onset of cerebral infarction, and analyzed the association between the platelet activation and the degree of atherosclerosis. Furthermore, prediction of the risk of cerebral infarction by assessing platelet activation was attempted. Thirteen patients with cerebral infarction, 7 patients with atherosclerosis and 8 healthy subjects were enrolled in this study. Ultrastructural shape change, peroxidase reaction, and fibrinogen content in the platelets were observed and plasma levels of thrombin antithrombin complex, α₂-plasmin inhibitor plasmin complex, β-thromboglobulin and platelet factor-4 were measured in patients with atherosclerosis and cerebral infarction at the acute, subacute and chronic phases. The ultrastructural shape change, peroxidase reaction, and fibrinogen content did not differ among acute, subacute and chronic phases of cerebral infarction. The frequency of platelet shape changes were also increased in patients with atherosclerosis, compared with healthy subjects. Plasma levels of β-thromboglobulin, platelet factor-4, and thrombin antithrombin complex increased only during the acute phase of cerebral infarction. It is suggested that platelet activation occurs before the onset of cerebral infarction and that platelet shape change is associated with the degree of atherosclerosis, or plaque stability. Platelet activation would be derived not from thrombotic event itself but from endothelial damage or pre-existing atherosclerosis. Platelet shape change, therefore, could predict the risk of cerebral infarction. Taken together with our previous reports demonstrating increased blood viscosity, noctural hypotension, increased human atrial natriuretic peptide, decreased fibrinolytic activity, and platelet shape change were observed after very hot hot-spring bathing, cerebral infarction in spa-resort could be caused partly by very hot hot-spring bathing after traveling on a tight schedule and alcohol drinking by elderly patients with atherosclerosis.

From March 1990 to September 2001, 24 patients with psoriasis (16 males and 8 females, 54±18 years) were admitted to our hospital to receive balneotherapy using Kusatsu hot-spring water. The psoriasis had been refractory to various treatments including steroid ointment therapy over a long period of time. The patients took a 10-minute 40-42°C hot-spring bath followed by application of vitamine D3 ointment 1-2 times daily for 37±19 days. The main components of the hot-spring water are aluminium, sulphates and chlorides, and its pH is 2.0. The skin symptoms of 20 of 24 cases (83%) were improved through the balneotherapy, while those of the remaining 4 cases were not changed. No side effects were observed. The serum levels of uric acid, GOT and GPT which are reported to be increased slightly did not correlate with the skin symptoms. The serum LDH level which is associated with the skin manifestastions in patients with atopic dermatitis also gave no useful information in the treatment of psoriasis. Although the mechanism of the improvement of skin manifestations is not clarified, balneotherapy at Kusatsu can be useful for the treatment of refractory cases of psoriasis as alternative and complementary medicine

A patient with atopic dermatitis who presented muscular weakness of lower extrimities and tetany due to severe hypokalemia, hypocalcemia and hypomagnemia was described. The hypokalemia and hypomagnemia were caused by pseudo-Bartter's syndrome due to persistent dehydration, and the hypocalcemia was caused by pseudohypoparathyroidism due to hypomagnemia. The persistent dehydration was considered to be resulted from long-term and long-time bathing. Thus, adequate supply of water and electrolytes may be necessary in long-term balneotherapy.

We have investigated change in platelets and the blood coagulation and fibrinolytic systems as a mechanism of the onset of thrombotic diseases during and after hot-spring bathing. In this study, We examined effect of 10min 42°C and 37°C hot-spring bathing on protein C, protein S and antithrombin III in seven healthy male subjects. The mean values of protein C antigen, protein C activity, total and fee protein S antigens, protein S activity and antithrombin III activity were slightly increased by both methods, while these changes were not statistically significant. Taken together with our previous reports, 10min 42°C hot-spring bathing gives no effect on the blood coagulation system.

The circumferences of chest, abdomen, thigh and calf during head-out water immersion up to chin level were measured in 8 healthy male subjects (age 35.4±1.6years old, body mass index 23.7±1.6kg/m²) in standing and sitting positions. The circumferences of chest, abdomen, thigh and calf decreased significantly during immersion in standing position. The circumferences of chest, abdmen and thigh decreased significantly in sitting position. The circumference of chest decreased from 90.6±3.4 to 90.1±3.1cm, that of abdomen decreased from 81.4±2.8 to 80.6±2.5cm, that of thigh decreased from 47.1±1.6 to 46.6±1.8cm, and that of calf decreased from 37.7±1.8 to 37.2±1.8cm during immersion in standing position. As the body surface area is about 1.6m², the decrease in the volume of human body is considered to be 730cm³ or less when the body shape change during immersion is not taken into considerarion.