Objectives: Locomotive syndrome (LS) leads to reduced physical function and a high risk of becoming bedridden.Grip strength serves as an indicator of upper limb and overall physical function. Rheumatoid arthritis (RA) patients with reduced grip strength frequently show finger and wrist joint inflammation. The purpose of this study was to verify grip strength as an evaluation tool for physical function and LS in RA patients. Methods: As part of an ongoing multicenter observational study, 591 consecutive RA patients whose background information was available, including data for the 25-question Geriatric Locomotive Function Scale (GLFS-25) and grip strength, were examined. LS was defined as a GLFS-25 score ≥ 16 points. Finger and wrist joint inflammation were defined as tender or swollen joints. Results: Among the 591 patients, 244 (41.3%) patients had LS, and 167 (28.3%) were male. Receiver operating characteristic curve analysis yielded cut-off values of grip strength for LS of 24 kg (specificity 72.2%; sensitivity 62.7%) for males and 17 kg (specificity 65.7%; sensitivity 67.6%) for females. Multivariable logistic regression analysis revealed a significant association of grip strength with LS, even after adjusting for finger and wrist joint inflammation. Conclusions LS was significantly associated with grip strength, even after adjusting for the presence of finger and wrist joint inflammation. We recommend adopting grip strength measurement as a screening tool for evaluating LS and guiding interventions.

Objective: Pharmacists need to know at what positioning a drug is recommended in clinical practice guidelines when they make prescription proposals.  However, the format of guidelines and the definition of recommendation grades differ between academic societies, making it difficult to comprehensively extract only the information one needs.  Therefore, we developed a guideline utilization system to support prescription proposals by pharmacists.
Methods: We built a database comprised of clinical practice guidelines on pharmacological therapy for breast cancer and breast cancer-related conditions.  FileMaker®was used in the development of the system.
Result: This system allows the comprehensive extraction of clinical questions and recommendations from multiple guidelines by means of standardized keywords.
Conclusion: This system supports prescription proposals by pharmacists when generating pharmacological therapy protocols or when in discussions with healthcare professionals as information on the positioning of therapeutic agents in different guidelines and recommended drugs is readily available.

The purpose of this 3-year retrospective study was to determine the efficacy and economic benefit of boiogito when administered concurrently with methotrexate (MTX) in patients with rheumatoid arthritis (RA). One hundred twenty-six patients who were treated at Ohno Clinic between May 2006 and November 2011 with either the MTX-boiogito combination (n = 59) or MTX alone (n = 67) were identified for the study. Eligible patients were selected on the basis of the 1987 American College of Rheumatology (ACR) criteria and their disease activity, while their remission rates and treatment outcomes were evaluated using the Disease Activity Score 28 Erythrocyte Sedimentation Rate (DAS 28-ESR). A total of 93 patients (MTX-boiogito group,n = 45 ; MTX alone group, n = 48) were included in the statistical analysis after excluding those who prematurely withdrew from the study due to adverse events or conditions that required treatment with biological agents.
Our results showed that the MTX-boiogito group had significantly lower disease activity (p = 0.0372),higher rates of remission (p = 0.0093), and greater improvement in overall DAS 28-ESR score (p = 0.0050) when compared to the MTX alone group. With the combination therapy group, fewer patients needed to add further disease-modifying anti-rheumatic drugs (DMARDs), and the total cost of medications over the 3 years was lower (2,145,470 JPY vs 2,301,690 JPY) with a resultant savings of 156,220 JPY per person. In conclusion, the use of boiogito 7.5 g/day represents a clinically and economically important addition to MTX therapy for the treatment of RA.

[Object]Any reports on acupuncture for patients with POEMS syndrome, which almost manifests disturbance of peripheral nerve in all cases and is known as a very rare disease together with disturbance of multiple organs, are not yet found. The present paper is concerned with a case report that improvement of symptoms and progress of ADL were brought out by acupuncture.
[Case]A sixty year-old man who was diagnosed as POEMS syndrome and received rehabilitation therapy after treatment with autologous peripheral blood stem cell transplantation complained of difficulty in walking with numbness in the lower legs at rest time and with numbness and muscular tension in the same sections after walking. Therefore, acupuncture was practiced once or twice per week for the patient in order to raise the threshold of pain and to relax muscular tension in the lower extremities.
[Results]After acupuncture, the patient could lengthen the walking distance, had reduced numbness in the soles and relaxation of muscular tension in the lower legs at rest time, and improved numbness after walking.
[Discussion and Conclusion]Acupuncture for a patient with POEMS syndrome resulted in improved symptoms and progress of ADL without severe side effects. From the above results, acupuncture is considered to be a useful therapeutic method used together with present medical treatment.

Traditional Chinese Medicine (TCM) revolves around the philosophical principles of Yin and Yang, and the Five Elements.The process of diagnosing, then treating with TCM, is called Bensho-Ronti (a traditional logic-based mythology). Specifically, it means diagnosing the patient (Bensho) using four diagnostic procedures, called Shishin, then formulating and applying therapies (Ronti) which correspond to the diagnosis. Herein, we survey the flow of this TCM.
Therapeutic procedure ; Medicine, Chinese Traditional ; System ; Diagnosis ; seconds

Effects of environmental (cold) stress and aging on cells in monocyte/macrophage lineage were investigated. We demonstrated that immune suppressive states seen in acute cold-stressed mice (8-10 weeks of age) is attributable to FcγRII(bright) suppressor macrophages. Serum corticosterone levels were markedly increased in acute cold-stressed mice. In addition, expression of glucocorticoids (GC) receptor mRNA was observed in FcγRII(bright) cells from these mice. The increase of FcγRII(bright) cells in peritoneal exudate cells caused by acute cold stress was inhibited by adrenalectomy or administration of a saturating amount of the GC antagonist RU 38486 (mifepristone). On the contrary, administration of the GC agonist, dexamethasone, markedly increased the proportion of FcγRII(bright) cells in peritoneal exudate cells of control mice. These results suggest that the generation of FcγRII(bright) suppressor cells of monocyte/macrophage lineage by acute cold stress was mediated by action of GC through the GC receptor. We likewise found that the proportion of FcγRII(bright) suppressor macrophages is increased in aged mice (22-24 months of age). Meanwhile, activated macrophages which function as antigen presenting cells were decreased in aged rats. Both the basal corticosterone concentrations in serum and the expression of mRNA for GC receptor in peritoneal macrophages increased significantly in aged animals, suggesting that these populational and functional changes of macrophages in aged animals were mediated, in part, by the increased basal levels of GC. This is probably being responsible for immunosenescence.

Effects of environmental (cold) stress and aging on cells in monocyte/macrophage lineage were investigated. We demonstrated that immune suppressive states seen in acute cold-stressed mice (8-10 weeks of age) is attributable to FcγRIIbright suppressor macrophages. Serum corticosterone levels were markedly increased in acute cold-stressed mice. In addition, expression of glucocorticoids (GC) receptor mRNA was observed in FcγRIIbright cells from these mice. The increase of FcγRIIbright cells in peritoneal exudate cells caused by acute cold stress was inhibited by adrenalectomy or administration of a saturating amount of the GC antagonist RU 38486 (mifepristone). On the contrary, administration of the GC agonist, dexamethasone, markedly increased the proportion of FcγRIIbright cells in peritoneal exudate cells of control mice. These results suggest that the generation of FcγRIIbright suppressor cells of monocyte/macrophage lineage by acute cold stress was mediated by action of GC through the GC receptor. We likewise found that the proportion of FcγRIIbright suppressor macrophages is increased in aged mice (22-24 months of age). Meanwhile, activated macrophages which function as antigen presenting cells were decreased in aged rats. Both the basal corticosterone concentrations in serum and the expression of mRNA for GC receptor in peritoneal macrophages increased significantly in aged animals, suggesting that these populational and functional changes of macrophages in aged animals were mediated, in part, by the increased basal levels of GC. This is probably being responsible for immunosenescence.
Neisseria gonorrhoeae ; Laboratory mice ; Acute ; Macrophages ; receptor

The effect of acupuncture electrotherapy (AET) on siccative symptoms (dry eye, dry mouth) of patients with Sjögren's syndrome (SjS) was examined using changes in the lacrimary secretion volume, the salivary secretion volume, and the skin temperature on the face as well as the dry score.
1) The control group (n=10) was subjected to 1-Hz/30-Hz AET on the face and 1-Hz AET on the posterior neck and upper scapula region. Though, the 30-Hz AET on the face resulted in a significant increase in the lacrimary secretion volume, salivary secretion voloume, and skin temperature on the face, no clear changes were observed in response to stimulus at the posterior neck and upper scapula region.
2) In one group of SjS patients (n=15), 30-Hz AET on the face significant increased the lacrimary secretion volume and salivary secretion volume.
3) In a second group of SjS patients (n=7), no significant difference in effects with elapsed time was observed immediately after, 30 minutes after. 1 hour after, and 2 hours after applying 30-Hz AET on the face.
4) In a third groups of SjS patients (n=10), no significant difference in the cumulative effect of 30-Hz AET applied to the face was observed after the first, fifth and tenth treatments. However, the dry mouth score significantly decreased from the first treatment to the tenth treatment.
The above observations indicate that the effect of AET on siccative symptoms of SjS patients occurs in the order of trigeminal nerve, facila nerves, and glosspharygeal nerve reflexes (somatic-parasympathetic nerve reflex). They also indicate that the reactivity varies according to the frequency of stimulation provided, with high-frequency stimulation being particularly effective in salivation, suggesting that acupuncture may contribute to improving the QOL of patients by mitigating the subjective siccative symptoms experienced by them.

Twenty-two patients with chronic glomerulonephritis were treated with Sairei-to (7.5g/day), either alone or in combination with camostat mesilate (600mg/day), to determine the efficacy and adverse effects of these regimens. Although there was significant improvement in proteinuria (p<0.05) after 8 weeks of treatment with Sairei-to alone, this was not longlasting. Combination therapy resulted in sustained significant improvement (p<0.03; there were two dropouts). No adverse effects were seen with either regimen. The results suggest that combination therapy using Sairei-to and camostat mesilate may be a safe and efficacious method of treatment for patients with chronic glomerulonephritis.

We experienced a case of polymyalgia rheumatica (PMR) which responded to Kampo medicine. A 53-year-old female patient first complained of stiffness and pain in the neck. Myalgia was severe and gradually eypanded to both shoulders and both upper extremities. Body weight decreased, and the erythrocyte sedimentation rate (ESR) was greater than 100mm/hour. Because her condition tended to improve when treated with prednisolone 10mg/day, she was diagnosed as having PMR. Her condition was well controlled until the dose of prednisolone decreased. Myalgia then recurred, and the ESR increased to 83mm/hour. The patient visited our outpatient department for treatment with Kampo therapy. Two months after treatment with Sairei-to plus Yokuinin-to, all signs and symptoms disappeared other than the stiff neck. Her body weight showed a tendency to increase. Six months after she first visited us, prednisolone was decreased and then stopped. Her condition still remains well controlled with this Kampo therapy alone. She has no clinical signs and symptoms, and the ESR has improved to 16mm/hour.