Objective: Combination therapy with glecaprevir and pibrentasvir (G/P) has been shown to provide a sustained virologic response (SVR) rate of >97% in patients with chronic hepatitis C virus (HCV) infection in the first published real-world Japanese data. However, a recently published study showed that the treatment was often discontinued in patients ≥75 years old, resulting in low SVR in intention-to-treat (ITT) analysis. Thus, our aim was to evaluate real-world data for G/P therapy in patients ≥75 years of age, the population density of which is high in “rural” regions.Patients and Methods: We conducted a multicenter study to assess the efficacy and safety of G/P therapy for chronic HCV infection, in the North Kanto area in Japan.Results: Of the 308 patients enrolled, 294 (95.5%) completed the treatment according to the protocol. In ITT and per-protocol analyses, the overall SVR12 rate was 97.1% and 99.7%, respectively. The old-aged patients group consisted of 59 participants, 56 of whom (94.9%) completed the scheduled protocol. Although old-aged patients tended to have non-SVR factors such as liver cirrhosis, history of HCC, and prior DAA therapies, the SVR12 rates in old-aged patients were 98.3% and 100% in the ITT and PP analyses, respectively. Of 308 patients enrolled, adverse events were observed in 74 patients (24.0%), with grade ≥3 events in 8 patients (2.6%). There was no significant difference in any grade and grade ≥3 adverse events between the old-aged group and the rest of the study participants. Only one patient discontinued the treatment because of adverse events.Conclusion: G/P therapy is effective and safe for old-aged patients.

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.

Objective: This study investigated the relationship between occupations and health status to obtain an overall understanding of a cohort of Japanese middle-aged women, including unemployed women, who comprised approximately 30% of the sample.Participants and Methods: Participants of this study were 4,454 women aged 40–69 years, classified into the following five groups based on their occupation: unemployed, 1,432; agriculture, 439; self-employed, 1,596; white collared, 793; and blue collared, 194. Participants’ perceived health was assessed using a symptoms checklist called the Todai Health Index (THI, later renamed as the Total Health Index) in a baseline survey conducted in 1993. The mortality risk of the participants was assessed using the Cox’s Proportional Hazards Model.Results: The means of the percentile values on the Total Scale 1 in the THI were as follows: agriculture, 43.7; unemployed, 50.8; self-employed, 52.5; white collared, 53.0; and blue collared, 56.1, with lower percentile values indicating better perceived health. The results showed that women engaged in agriculture were in significantly better health than were those in the other four occupations. The hazard ratios (HRs) and 95% confidence intervals of the occupational groups adjusted for age, area of residence, and Total Scale 1 scores were as follows: agriculture (reference group), 1; white collared, 1.16 (0.77–1.74); self-employed, 1.25 (0.87–1.78); unemployed, 1.27 (0.91–1.77); and blue collared, 1.50 (0.86–2.60).Conclusions: Women engaged in agriculture had a significantly higher tendency to have a better health status on the THI as compared to those from the other four occupational groups, and they exhibited the lowest HR as compared to their counterparts, though not statistically significant. We concluded that the perceived health status of unemployed women was similar to that of women engaged in agriculture.

We report a case of reoperation for proximal and distal pseudoaneurysmal formations of the ascending aorta with aortic regurgitation (AR) after an ascending aorta replacement for acute type A aortic dissection. The patient was a 69-year-old woman who had undergone ascending aorta replacement for acute type A aortic dissection six years previously. Subsequent development of pseudoaneurysms of the ascending aorta and aortic regurgitation were revealed by computed tomography and echocardiography respectively. We chose debranch Thoracic Endovascular Aortic Repair (TEVAR) with a staged approach. First, aortic valve replacement, patch closure of proximal pseudoaneurysmal formation, coronary artery bypass, and ascending aorta-axillary artery bypass were performed. Two weeks later, debranching and TEVAR were performed. Cardiac reoperation for proximal and distal pseudoaneurysmal formations of the ascending aorta with aortic regurgitation after an ascending aorta replacement is known to be high risk. Nevertheless we performed the operation safely in two-stage surgery.

Objective: To investigate the effect of the roselle calyx extract (RCE) (Hibiscus sabdariffa L.) on the in vitro viability and biofilm formation ability of oral pathogenic bacteria. Methods: RCE was prepared by soaking roselle calyx powder with ethyl alcohol for 24 h at room temperature. After centrifugation, the extract was lyophilized. Then, the extract was dissolved in phosphate-buffered saline, the pH was adjusted, and the extract was aseptically filtered. We used Streptococcus mutans, Streptococcus sanguinis, Lactobacillus casei, Actinomyces naeslundii, Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum, Porphyromonas gingivalis and Prevotella intermedia in this study. The antibacterial activity of the RCE was determined by treating the cells of these bacteria with the extract for 10 or 20 min at room temperature. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration was determined using the microdilution method, and the effect of the RCE on the ability to form biofilm was determined using a polystyrene micro plate assay. In addition, we used the WST-1 assay to determine the cytotoxicity of the RCE on HGF, Ca9-22 and KB cells. Results: The RCE had antibacterial activity against oral bacteria used in this study. In particular, most significant antibacterial activity was observed against Fusobacterium nucleatum, Prevotella intermedia and Porphyromonas gingivalis. The MIC and minimum bactericidal concentration were 7.2 mg/mL-28.8 mg/mL and 14.4 to >57.6 mg/mL. The RCE had an inhibitory effect on biofilm formation at the MIC and sub-MIC levels. In addition, the RCE had low cytotoxic effects on HGF, Ca9-22 and KB cells. Conclusions: Thus, our results indicate that the RCE may be used for preventing oral diseases.

[Purpose] We know of no reports on the effects of electro-acupuncture (EA) stimulation, on human skeletal muscle blood flow (MBF), examined quantitatively with a direct method. Therefore, we investigated changes in MBF before, during and after EA with a new clearance method. [Methods] Ten healthy adult volunteers (8 men and 2 women; median age 30.5 years) were given EA to the trapezius at the BL 10 and GB 21 acupoints, employing the left trapezius as the non-EA side to contrast with the right trapezius as the EA side, and using stainless needles of 50 mm length and 0.18 mm gauge. MBF data were surveyed for 2 minutes before EA, for 4 minutes during EA, and for 4 minutes after EA, and a total of10minutes were analyzed l(?). Blood pressure and heart rate were simultaneously measured. [Results] MBF on the EA side increased significantly during EA (p < 0.05). On the other hand, diastolic blood pressure and heart rate were shown to decrease during EA (p < 0.05). [Discussion] These results, showing that MBF increased on the EA side, while diastolic blood pressure and heart rate decreased, suggest a regional muscle pump action with EA. [Conclusion] In evaluating a new, direct means of quantitatively examining _99mTc0_4- clearance, an increase in MBF with right side EA stimulation was clearly shown. Because the present method is simpler and easier, and higher in accuracy than past methods, we believe it may be used more aggressively in future clinical studies of acupuncture/moxibustion.

Since James Reston's Acupuncture experiece in Beijin in 1971, America opened her eyes to acupuncture. In the 1980's, Joseph M. Helms, M.D.at UCLA studied Chinese acupuncture in France and established AAMA (American Academy of Medical Acupuncture) for physicians and authored his book “ACUPUNCTURE ENERGETICS” which has become the golden textbook for physician acupuncturists. His “energizing” tech-nique for various illness became the standard, Of course, other modalities have been utilized. With Helms' in-fluence, AAMA has grown to 2000 members including those outside the USA. In 2000, ABMA (American Board of Medical Acupuncture) was developed for the physician acupuncturists certified as experts in the field of medical acupuncture. The members are working and studying diligently. At the end of this report, I will discuss my own practice.

A 41-year-old woman with neurofibromatosis (NF) was admitted to our hospital for severe pain and right leg swelling of 5 days duration. Paralysis of the right leg due to compartment syndrome was also recognized. She had been diagnosed as von Recklinghausen's neurofibromatosis, previously. 3 D-computed tomography showed a ruptured anterior tibial artery aneurysm. There was a normal patent posterior tibial artery. Since her complaint of pain was severe, we performed an emergency operation. Under the pneumatic tourniquet technique, the aneurysm was resected, and both the proximal and distal sides of the anterior tibial artery were ligated. A massive hematoma was completely removed. Postoperatively, the dorsalis pedis and posterior tibial pulses remained palpable. The paralysis improved considerably and she was given an ambulatory discharge from our hospital 21 days after the operation. Histological examination revealed proliferating wavy spindle cells infiltrating between the adventitia and mesothelium of the aneurysmal wall and staining positively for S 100 immunoperoxidase.

We describe a young adolescent patient with spontaneous abdominal aortic rupture who was treated successfully. A 14-year-old boy was admitted to our hospital with severe abdominal pain and hypovolemic shock, without any episode of trauma. Computed tomography (CT) revealed massive hematoma in the retroperitoneal space and extravasation of copious amounts of contrast medium in front of the terminal aorta. Neither aortic aneurysm nor dissection was observed in this CT. An emergency operation was carried out. At first, left thoracotomy and clamping of the thoracic descending aorta were performed in order to reduce the aortic bleeding. Midline laparotomy revealed an aortic perforation of approximately 8mm at the bifurcation of the abdominal aorta. The aortic wall surrounding the perforation was nearly normal without any aortic aneurysm or dissection. A segment of the terminal aorta (length, 3cm) including the perforated lesion was excised and reconstruction was performed with a woven Dacron tube graft (10mm in diameter). On microscopic examination, the marginal tissue near the perforation showed diminished elastic fibers and minimal dissection of the medial layer of the aortic wall; however, no cystic medial necrosis or inflammation was seen.

Our goals are to review the literature on the definition and epidemiology of fecal incontinence (FI), the risk factors involved, available treatment options, and measurement of the quality of life (QOL) of patients with this condition. Articles included for review were searched following the guidelines set by Cochrane Reviewers' Handbook. FI was defined variously depending upon the duration, type, and amount of leakage. About 17 published papers were reviewed on the prevalence of FI that ranged from 1.4% to 50%. Potential risk factors included perianal injury/surgery, and fair/poor general health. QOL assessment using various grading scales provided an objective method of evaluating patients before and after treatment. Management included medical, physiotherapy, and surgical options. Through the range of various references, a clear definition of FI should be specified, which reflects its epidemiology in the various studies. These differences in definition would significantly affect its prevalence. Many risk factors have been sited but further epidemiological studies are necessary to elucidate FI. Understanding the etiology of the disease is an important initial step to provide adequate treatment of FI. QOL assessment provides objective and subjective method in the analysis of effectiveness of therapy.