Methods: Lateral radiographs were obtained from 100 healthy adults in standing and seated postures at 25°, 35°, and 45° recline angles. Spinal parameters (cervical lordosis, thoracic kyphosis, thoracolumbar kyphosis, lumbar lordosis, sacral slope, pelvic tilt, and T1 spinopelvic inclination) and seat belt metrics (X-value, Z-value, and lap belt angle) were measured. Multivariate regression was used to assess associations with sex, age, height, and body mass index (BMI). Results: Reclining reduced cervical/lumbar lordosis and sacral slope, while thoracic kyphosis and pelvic tilt increased. Higher BMI was associated with a cranially shifted and more horizontal lap belt. Taller individuals showed greater T1 spinopelvic inclination and pelvic parameters. Females exhibited more pronounced thoracic kyphosis and pelvic retroversion across reclining angles. Conclusions Car seat recline significantly alters spinal alignment and seat belt positioning, with changes influenced by age, height, and BMI. These findings support ergonomic improvements in seat design and may inform surgical planning for ASD.

It is written about daiobotampito in ‘Jin Gui Yao Lue' that the patients who should be treated with the for­mula urinated smoothly. On the other hand, Kampo doctors today tend to use daiobotampito for difficulty of urination. We investigated the feature of daiobotampito in old medical textbooks, especially about “urination,” “gonorrhea,” and “intestinal abscess.” We searched old medical textbooks for daiobotampito, which were writ­ten or published before or during the Song Dynasty. In the textbooks other than ‘Jin Gui Yao Lue,' it is written that the patients urinated frequently. In the textbooks other than ‘Jin Gui Yao Lue' and ‘Ishimpo,' it is written that the patients sometimes urinated difficultly. In the old medical textbooks before or during the Song Dynasty, urination of the patients who should be treated with daiobotampito was smooth but sometimes difficult.

Kampo physicians in the Showa era, such as ARAKI Seiji and OTSUKA Keisetsu, had called raw ginger as the herbal medicament “ginger”, and processed or unprocessed dried ginger as the medicament “processed gin­ger”. However, many Kampo physicians in the present Japan call unprocessed dried ginger as the medicament “ginger”, and processed dried ginger as the medicament “processed ginger”. The aim of this study is to investi­gate the background of the process of this change from the Showa era to the present. We searched the defini­tions of the medicaments “ginger” and “processed ginger” in successive Japanese Pharmacopoeia editions and other related books describing these definitions. In Japanese Kampo medicine before the Showa era, the herbal medicament “ginger” had referred to raw ginger, and the medicament “processed ginger” had referred to proc­essed or unprocessed dried ginger. However, after the Heisei era, the medicaments “ginger” and “processed ginger” have referred to unprocessed dried ginger and processed dried ginger, respectively. And the raw ginger has been called as “preserved ginger”.

We report two cases of irritable bowel syndrome (IBS) with predominant constipation successfully treated with daijokito and then diagnosed as Alzheimer's dementia. [Case 1] An 82-year-old man. He had been treated for IBS with probiotic and purgative. However, the symptom of IBS did not get cured and he had suffered from digestive symptom with iracund mental condition. [Case 2] A 74-year-old man. He suffered from abdominal pain and constipation so he needed enema and stool extraction frequently. He sometimes angered if he could not get treatment without delay. In both cases, their bowel and mental condition improved after treatment with daijokito. After their conditions improved, we checked their cognitive function, and found the levels of their cognitive function were low. We diagnosed them as Alzheimer's dementia. The patients probably had felt the difficulty and gotten mental stress on usual days because of dementia, so the mental stress could complicate the symptoms of IBS. Daijokito probably improved the digestive symptom due to IBS and the mental stress from dementia of these patients, and after the treatment we could diagnose the dementia. Elderly patients with constipation and iracund mental condition might have dementia.

We report a case of a 39-year-old female who suffered from generalized anxiety disorder for 3 years after a spontaneous abortion and was successfully treated with kyukichoketsuin. She got generalized anxiety disorder and had difficulty to stay in a crowd after she had a spontaneous abortion at the age of 36. She visited our Kampo clinic because of the anxiety at her age of 39. We prescribed her yokukansankachimpihange for 6 months, but she still suffered from anxiety. After we changed yokukansankachimpihange to kyukichoketsuin, her anxiety improved. Kyukichoketsuin is a formula for various kinds of bad conditions during the postpartum period, which was described as the first therapeutic agent in “Manbyokaishun.” In this case, although the patient had suffered from mental disorder for three years after a spontaneous abortion, she showed a favorable response to kyukichoketsuin treatment. This result suggests that kyukichoketsuin may be effective for years of mental problems after parturition.

BACKGROUND/AIMS: In distal malignant biliary obstruction, an antireflux metal stent (ARMS) with a funnel-shaped valve is effective as a reintervention for metal stent occlusion caused by reflux. This study sought to evaluate the feasibility of this ARMS as a first-line metal stent. METHODS: Patients with nonresectable distal malignant biliary obstruction were identified between April and December 2014 at three Japanese tertiary centers. We retrospectively evaluated recurrent biliary obstruction and adverse events after ARMS placement. RESULTS: In total, 20 consecutive patients were included. The most common cause of biliary obstruction was pancreatic cancer (75%). Overall, recurrent biliary obstruction was observed in seven patients (35%), with a median time to recurrent biliary obstruction of 246 days (range, 11 to 246 days). Stent occlusion occurred in five patients (25%), the causes of which were sludge and food impaction in three and two patients, respectively. Stent migration occurred in two patients (10%). The rate of adverse events associated with ARMS was 25%: pancreatitis occurred in three patients, cholecystitis in one and liver abscess in one. No patients experienced non-occlusion cholangitis. CONCLUSIONS: The ARMS as a first-line biliary drainage procedure was feasible. Because the ARMS did not fully prevent stent dysfunction due to reflux, further investigation is warranted.
Arm ; Asian Continental Ancestry Group ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Cholecystitis ; Drainage ; Humans ; Liver Abscess ; Pancreatic Neoplasms ; Pancreatitis ; Pilot Projects* ; Retrospective Studies ; Sewage ; Stents*

BACKGROUND/AIMS: Endoscopic placement of self-expandable metal stents (SEMSs) has emerged as a palliative treatment for malignant gastric outlet obstruction (GOO). Although covered SEMSs can prevent tumor ingrowth, frequent migration of covered SEMSs may offset their advantages in preventing tumor ingrowth. METHODS: We conducted this multicenter, single-arm, retrospective study at six tertiary referral centers to evaluate the safety and efficacy of a partially covered SEMS with an uncovered large-bore flare at the proximal end as an antimigration system in 41 patients with symptomatic malignant GOO. The primary outcome was clinical success, and the secondary outcomes were technical success, stent dysfunction, adverse events, and survival after stent placement. RESULTS: The technical and clinical success rates were 100% and 95%, respectively. Stent dysfunctions occurred in 17 patients (41%), including stent migration in nine (23%), tumor ingrowth in one (2%), and tumor overgrowth in four (10%). Two patients (5%) developed adverse events: one pancreatitis and one perforation. No procedure-related death was observed. CONCLUSIONS: A novel partially covered SEMS with a large-bore flare proximal end was safe and effective for malignant GOO but failed to prevent stent migration. Further research is warranted to develop a covered SEMS with an optimal antimigration system.
Gastric Outlet Obstruction* ; Humans ; Palliative Care ; Pancreatitis ; Retrospective Studies ; Self Expandable Metallic Stents ; Stents* ; Tertiary Care Centers

Kanzoshashinto consists of seven medicinal herbs including ginseng. The formula for kanzoshashinto in the Chinese medical text “Jinguiyaolue” consists of the seven herbs, but its formula in “Shanghanglun,” a second medical reference, lists only six herbs and does not include ginseng. We investigated if formulas for kanzoshashinto in traditional Chinese and Japanese medical books included ginseng. We searched modern Japanese databases using the terms kanzoshashinto and ginseng. We also searched medical books written during the Song Dynasty in China and the Edo period in Japan. We found one article in a modern Japanese database that discusses kanzoshashinto and ginseng. The article stated that kanzoshashinto formula included ginseng only described in the Song medical text Jinguiyaolue. Kanzoshashinto formula in other ancient Chinese medical references did not list ginseng as one of the components of the medicine. This research confirmed the statements written in ancient Chinese medical references : doctors could add ginseng to kanzoshashinto. During the Edo period in Japan, most doctors prescribed a kanzoshashinto formulation that included ginseng. In the medical reference “Jinguiyaolue,” kanzoshashinto with ginseng is described as a treatment for kowaku, an unstable psychological state. In the medical reference “Shanghanglun,” kanzoshashinto without ginseng was used to treat severe diarrhea. Therefore, it is possible that kanzoshashinto without ginseng might be a more effective treatment for diarrhea. Further studies are required to examine the efficacy of kanzoshashinto without ginseng in treating severe diarrhea.

We report the case of a 17-year-old male who had involuntary movements treated with yokukansankashakuyakukoboku. He had first recognized the involuntary movement 6 years previously. His symptom could not be alleviated with neurological and psychological treatments, and he visited our clinic for treatment with Kampo medicine. His symptom gradually alleviated with yokukansankashakuyakukoboku. The ancient physician Sekki (薛已) created yokukansan in China's Ming Dynasty. Yokukansan and its various add-on combinations were used in the Edo Era of Japan. Keisetsu Ohtsuka then created yokukansankashakuyakukoboku, which is however now rarely used because there is no extract drug in Japan. There are markedly nervous patients however, who can be treated with this formula. Thus, the authors feel that more research needs to be done on the differences between yokukansan and yokukansankashakuyakukoboku.

Introduction : The purpose of this study was to clarify the antimicrobial susceptibility of Haemophilus influenzae in central Tokyo over a ten-year period.
Methods : We investigated the susceptibility of Haemophilus influenzae isolated in Tokyo Saiseikai Central Hospital for 10 years from 2004 through 2013.
Results : Significant increases in the proportion of strains resistant to ampicillin, ampicillin / sulbactam and cefditoren pivoxil were noted for some years in comparison to the first year studied. There were no significant changes in the susceptibility to levofloxacin and clarithromycin. The proportion of strains resistant to ampicillin and cefditoren pivoxil showed statistically significant increases during the study period. The proportion of the strains resistant to ampicillin / sulbactam isolated from children was greater than from adults for every year studied. Levofloxacin resistant strains were isolated only from adults. The proportion of strains resistant to clarithromycin were about 1% in Japanese national surveillance data, but the proportions in this study were over 9%.
Conclusion : Over a ten-year period in central Tokyo, Haemophilus influenzae strains resistant to ampicillin and cefditoren pivoxil increased. Strains resistant to clarithromycin occurred at a higher rate than nationally.