Some simulation-based education tools have been introduced in Kampo medicine. However, there are only a few brief simulation tools to learn qi-blood-fluid (QBF) patterns of traditional Chinese medicine (TCM). In this study, we developed a self-diagnostic questionnaire that allows students learn TCM interviews and QBF patterns by answering the questionnaire and evaluated its reliability and validity. We extracted questionnaire items to classify six QBF patterns (qi deficiency, blood deficiency, yin deficiency, qi stagnation, blood stasis, and phlegm-fluid retention) based on some textbooks of TCM and Kampo medicine. Then we developed an initial questionnaire comprising 35 items. Fifth year medical students at Tohoku University School of Medicine answered the questionnaire of small group teaching during 2017-2020. We evaluated the accuracy of the questionnaire if compared with the diagnosis of academic supervisors. To improve the accuracy, we adjusted the questionnaire’s thresholds and created a predictive model of the patterns using logistic regression analysis. The questionnaire’s sensitivity improved by adjusting the thresholds. Logistic regression analysis resulted in a predictive model that could determine QBF patterns with the same level of accuracy as the original for 20 items overall. The results suggest that the use of a simple questionnaire with ensured accuracy may contribute to better pre-graduate education by making it easier for students to understand their own Kampo medicine patterns.

Prolonged cough in coronavirus disease 2019 (COVID-19) is not only uncomfortable for patients, but also prolongs the length of stay in an isolation facility. This results in delays in patients' return to their daily life. Therefore, the prompt treatment of cough is important. In this report, we used Japanese traditional (Kampo) medicine, chikujountanto for the treatment of cases with residual cough, airway secretions, slight fever, anxiety, and insomnia, several days after the onset of coronavirus. From October 2020 to September 2021, we prescribed chikujountanto for thirty-three COVID-19 patients with prolonged cough in an isolation facility. Seven patients (6 women and 1 man with ages ranging 37-70 years) were treated with no other medication. Comorbid symptoms included slight fever, sputum, sore throat, nasal discharge, headache, anxiety/insomnia, and taste/olfactory disorders. The start date of treatment ranged from 9 to 21 days after the onset of COVID-19, and the time until cough and comorbid symptoms improved to values less than NRS 2 or less, was 2 to 6 days after treatment. Three patients had persistent cough and needed to switch to other medication. In COVID-19, chikujountanto may be useful for coughing during the period when the peak of the viral proliferative phase has passed but airway inflammation is still present.

Objective: To clarify the frequency of deficient mismatch repair (dMMR) in Japanese ovarian cancer patients, we examined microsatellite instability (MSI) status and immunohistochemistry (IHC) subtypes, including endometrioid carcinoma (EMC), clear cell carcinoma (CCC), or a mixture of both (Mix). Methods: We registered 390 patients who were diagnosed with EMC/CCC/Mix between 2006 and 2015 and treated at seven participating facilities. For 339 patients confirmed eligible by the Central Pathological Review Board, MSI, IHC, and MutL homolog 1 methylation analyses were conducted. The tissues of patients with Lynch syndrome (LS)-related cancer histories, such as colorectal and endometrial cancer, were also investigated. Results: MSI-high (MSI-H) status was observed in 2/217 CCC (0.9%), 10/115 EMC (8.7%), and 1/4 Mix (25%). Additionally, loss of MMR protein expression (LoE-MMR) was observed in 5/219 (2.3%), 16/115 (14.0%), and 1/4 (25%) patients with CCC, EMC, and Mix, respectively. Both MSI-H and LoE-MMR were found significantly more often in EMC (p<0.001). The median (range) ages of patients with MMR expression and LoE-MMR were 54 (30–90) and 46 (22–76) (p=0.002), respectively. In the multivariate analysis, advanced stage and histological type were identified as prognostic factors. Conclusion The dMMR rate for EMC/CCC was similar to that reported in Western countries. In Japan, it is assumed that the dMMR frequency is higher because of the increased proportion of CCC.

At Saitama Medical University, experience training for first-year medical students was conducted for the purpose of communicating with people who live in an institution and have severe motor and intellectual disabilities. However, due to the spread of COVID-19, training at this institution has been suspended completely, which has led us to conduct the training remotely. In the remote training sessions, people with disabilities who only had nonverbal communication tools joined a Zoom meeting where they were able to communicate with students from inside the institution. In the past, there have been other times when training was suspended due to infectious disease outbreaks. Despite this, remote training has made it possible to carry out training without being affected by the environment. Compared to conventional training, remote training did not allow students to experience the atmosphere of the institution or interaction with the people on-site. However, it did have other advantages in that it enabled students to understand the disabilities at a deep level, making them realize the importance of nonverbal communication, and increasing their motivation to learn.

BACKGROUND: This study examined the relationships between stress responses and lifestyle, including sleeping and eating behaviors, in Japanese workers according to sex. METHODS: Questionnaires about stress responses and lifestyle were completed by 3,017 workers in a financial enterprise (41.5% men, 58.5% women). Data were collected in Japan in August 2011. Participants were classified into stress and nonstress groups. Relationships between stress responses and lifestyle were investigated using logistic regression analysis with stress response as a dependent variable. RESULTS: There were 254 (8.4%) participants in the stress group and 2,763 (91.6%) in the nonstress group. The results showed that sleeping for shorter periods [odds ratio (OR) = 2.97, 95% confidence interval (CI): 1.58-5.60] was associated with stress responses in women, whereas we found no relationship between stress responses and lifestyle among men. However, working overtime was associated with stress responses in men (OR = 2.71, 95% CI: 1.43-5.15). Eating at night was associated with stress responses in the univariate analysis (men: OR = 2.10, 95% CI: 1.16-3.80; women: OR = 1.61, 95% CI: 1.09-2.39). CONCLUSION: This study showed that stress responses were related to lifestyle among women but not among men. Among women, stress responses were related to sleeping for shorter periods, whereas they were related to working long hours among men. In addition, stress responses were related to eating at night in the univariate analysis, although this relationship was not seen in the multivariate analysis, in either sex.
Asian Continental Ancestry Group* ; Eating ; Feeding Behavior ; Female ; Humans ; Japan ; Life Style* ; Logistic Models ; Male ; Multivariate Analysis ; Surveys and Questionnaires ; Sex Characteristics*

Objectives
In recent years, the importance of ethics in the nursing has been increasing, and ethical practices the nursing professionals are being demanded. In global nursing, for instance when Japanese nurses work in a developing country, they face different socioeconomic status and cultures. These characteristics may affect the ethical aspect. However, no literature review of Global Nursing Ethics (GNE) has been conducted until now. The purpose of the integrative literature review is to investigate the literature concerning GNE from the viewpoint of the kind of literature, the countries where the primary authors live, and the major topics related to ethics.We then will generalize on the present condition of GNE.
Methods
Our review was based on the methodology of Cooper's integrative review. We searched the literature of the last ten years using the Pubmed database, CHINAL, and Japana Centra Revuo Medicina. 86 literatures that met our criteria were analyzed.
Results
1. 53 out of the 86 literatures contained “Information”.
2. Regarding where the primary authors live, 42 live in the United States, 11 in the United Kingdom, and seven in Canada.
3. The numbers of major topics reviewed were: 1) nursing ethics between each country, (a) 21 ethical issues related to immigration of nurses, (b) ten related to global nursing cooperation, (c) seven regarding comparison of nursing ethics between countries; 2) nursing ethics on a global scale, (a) 12 related to interpretation and use of global code of ethics for nurses, (b) 11 related to ethical consideration in global nursing research.
Conclusions
1. Most literatures contained “Information”, and this indicates that the knowledge of GNE has been spreading. Although the importance of GNE has been recognized, future research may be required.
2. The top three authors are from English speaking countries indicating that geographical bias exists in the countries that deal with GNE.
3. GNE depends on the context, so, it is necessary to pay attention to where and how they are used.

  In our hospital the palliative care committee has been held once a month since 2000. In 2007, a total of 1,583 cancer patients were admitted to our hospital orreceived medical care at home. The average length of hospital stay was 24 days. Of the total number of patients, 88.4% was informed that they had cancer. In the latter half of the year it increased to 92.6% because the palliative caretakers gave doctors accurate information on patients' psychology and social background. In October 2007 a questionnaire survey was conducted on those who visited our palliative care section on the occasion of the hospital festival. A total of 46 responded to our survey about the knowledge of palliative care, physician's precise explanation about the illness, image of opioids, desirable place of death and so on. Twenty-eight respondents (60.9%) did not know anything about palliative care. Forty-four (95.7%) wanted precise explanation of cancer. Thirty-four (73.9%) said they had had a night image of opioids after reading the panel. Twenty-eight (60.9%) responded they would rather stay at home until death. We should give healthy people more information about palliative care and opioids.

The number of fatalities in Japan attributable to lung cancer exceeded 50000 in 2001. It is socially desirable that various markers, which can be utilized for the prevention of lung cancer, be established. We believe that smoking or exposure to carcinogens in air induces mutations in bronchial and alveolar epithelia, leading to the development of lung cancer. It would be useful to have markers of individual differences in susceptibility to chemical carcinogen-induced lung cancer 1) to identify genetic polymorphisms of enzymes metabolizing chemical carcinogens and 2) to investigate the expression of enzymes metabolizing chemical carcinogens. In this paper, we review CYP expression in the bronchial epithelium. CYP1, CYP2 and CYP3 are expressed in the bronchial epithelium. We also show the relationship between the genetic polymorphisms of cytochrome P450 (CYP) and a person's susceptibility to chemical carcinogen-induced lung cancer. We demonstrate the relationship between cigarette consumption and the CYP expression profile in the bronchial epithelium. To maintain and promote public health, we must apply evidence, such as CYP polymorphisms and CYP profiles to disease prevention and also to aggressively advance evidence-based prevention (EBP) of lung cancer.

To investigate the effects of Kampo and a rehabilitation approach on patients with spinocerebellar degeneration (SCD), a 65-year-old female patient with SCD was treated with Ogi-kenchu-to and therapeutic exercise based on the Bobath concept.
She had a gait disturbance (unable to walk) with slightly increased muscle tonus and deep sensory disturbance in the left leg before therapy. In Kampo confirmations, there was a generalized cold feeling and fatigue due to decreased physical fitness. In the electrophysiological study, the amplitude of Auditory Brainstem Responses (ABR) and Somatosensory Evoked Potentials (SEP) in the left side showed a greater decrease than those in the right side. The amplitude of the F-wave in the left side showed a greater increase than that of the right side.
After two months of this therapy, the patient was able to walk unassisted. Improvement in the neurological and general findings, along with normalization of the ABR, SEP and F-wave were also observed.
It was suggested that Kampo therapy using Ogi-kenchu-to and therapeutic exercise based on the Bobath concept were effective in the treatment of this patient with SCD.