Objective: The purposes of this trial were to demonstrate the feasibility and effectiveness of the hybrid of intracavitary and interstitial brachytherapy (HBT) for locally advanced cervical cancer patients in the phase I/II prospective clinical trial. Methods: Patients with FIGO stage IB2-IVA uterine cervical cancer pretreatment width of which was ≥5 cm measured by magnetic resonance imaging were eligible for this clinical trial. The protocol therapy included 30–30.6 Gy in 15–17 fractions of whole pelvic radiotherapy concurrent with weekly CDDP, followed by 24 Gy in 4 fractions of HBT and pelvic radiotherapy with a central shield up to 50–50.4 Gy in 25–28 fractions. The primary endpoint of phase II part was 2-year pelvic progression-free survival (PPFS) rate higher than historical control of 64%. Results: Between October 2015 and October 2019, 73 patients were enrolled in the initial registration and 52 patients proceeded to the secondary registration. With the median follow-up period of 37.3 months (range, 13.9–52.9 months), the 2- PPFS was 80.7% (90% confidence interval [CI]=69.7%–88%). Because the lower range of 90% CI of 2-year PPFS was 69.7%, which was higher than the historical control ICBT data of 64%, therefore, the primary endpoint of this study was met. Conclusion The effectiveness of HBT were demonstrated by a prospective clinical study. Because the dose goal determined in the protocol was lower than 85 Gy, there is room in improvement for local control. A higher dose might have been needed for tumors with poor responses.

Here, we report a case of nocturnal enuresis persisting into adulthood treated with Kampo medicine. A 21-year-old woman had a history of nocturnal enuresis every night during childhood and once every 2-3 nights during school age. Although the frequency of urinary incontinence decreased to 1-2 times/week at 19 years of age, nocturnal enuresis persisted into adulthood. She was diagnosed with mild strain of the rectus abdominis muscles and palpable abdominal aortic pulsation above the umbilicus, and keishikaryukotsuboreito (decoction) therapy was initiated. She did not experience urinary incontinence at night for 3 weeks, except for one episode immediately after treatment commencement. She tended to urinate only 4 times from the time she awoke until bedtime ; therefore, we added a small amount of goreisan to her treatment regimen to increase the urinary output and daytime frequency of urination. The frequency of urination increased from 4 to 7 times and stabilized. We discontinued goreisan administration 2 months later, and keishikaryukotsuboreito monotherapy was continued. We did not observe recurrent nocturnal enuresis and, therefore, switched the decoction to an extract. After the symptom stabilized, the dosage of keishikaryukotsuboreito was reduced by half. Nocturnal enuresis occurred only once when the patient missed a dose for 3 consecutive days but did not recur for over 4 months after strict adherence to medication. This case report highlights the role of Kampo therapy as an effective therapeutic option for nocturnal enuresis persisting into adulthood.

A survey was conducted to determine the current status and issues of dysphagia care in hospitals and long-term care facilities in Gifu Prefecture. Responses were obtained from 14 hospitals, 13 welfare facilities for elderly adults requiring long-term care (WFs), and 13 geriatric health services facilities (GHSFs). Dysphagia teams were present at 12 hospitals, 4 WFs, and 8 GHSFs. The teams primarily consisted of general nurses (hospitals = 12, WFs = 4, GHSFs = 8; same order below), certified dysphagia nurses (11, 1, 0), nutritionists (11, 4, 7), speech-languagehearing therapists (11, 0, 5), physicians (7, 2, 4), and pharmacists (7, 0, 0). Facilities that employed certified dysphagia nurses conducted screening for dysphagia, but many hospitals and long-term care facilities did not review patients’ medications to identify medications that could cause dysphagia. In addition, many hospitals did not educate care workers about assisting with eating and swallowing. This demonstrates a need to improve dysphagia-related screening and educational systems for nurses and care workers at hospitals and long-term care facilities.

A 47-year-old woman visited our clinic, and thereafter she had taken various Kampo medicines until she turned 58 years old. She took each medicine, containing 1-3.5 g/day of glycyrrhiza, for one or two months. Hypertension or edema was not observed in those days. From the age of 60, she took 7.5 g of tokishigyakukagoshuyushokyoto, containing 2 g of glycyrrhiza, day after day. Hypertension or edema was not observed for 35 months. However, when she was 63 years old, pseudoaldosteronism with headache, hypertension, edema,and hypopotassemia was observed for the first time. This case suggests that administration period or patient's age influences the development of pseudoaldosteronism.

To clarify the views and needs on Rx-to-OTC switches in patients afflicted with lifestyle-related diseases such as hypertension, diabetes and/or hyperlipidemia, our survey was conducted with 199 patients at a pharmacy in Tokyo, Japan.Of the 199 patients, 159 people were patients afflicted with lifestyle-related diseases.One hundred and ten patients afflicted with lifestyle-related diseases were seventy-year-old and older, and 149 of the patients have been to a hospital at least once in the past year.Thirty-six point five percent of the patients afflicted with lifestyle-related diseases replied that they wanted to use Rx-to-OTC switches when they had been ill and/or injured.The main reasons that they wanted to use Rx-to-OTC switches were “convenience” and “always the same drugs”.On the other hand, the main reason that they did not want to use Rx-to-OTC switches was “I want to have a detailed examination”.Twenty-three point nine percent of them replied that they wanted to switch their prescription drugs to Rx-to-OTC switches. We believe that the usage of Rx-to-OTC switches after the establishment of a support system to secure safety can be the answer to the issues of the rise in medical care expenditures and doctor shortage.

Background: In one series of studies, we observed the effects of acupuncture treatment (AT) on the autonomic nerve system (ANS). We experimented from various view-points. At last, we discovered a specific pattern for modifying ANS status, which showed that functions of the parasympathetic nerve increased while those of the sympathetic nerve decreased. To further study systematic modification of ANS balance, we focused on the lower body (feet). Moreover, two kinds of stimuli, tapping and vibration, were applied while measuring the value of finger floor distance (FFD) and heart rate (HR). Finally, the effects on ANS were discussed. Methods: Twenty healthy subjects participated in this study, and they were divided into two groups; the tapping group and the vibration group. The former received 50 taps on the feet, and the latter received vibrations for two minutes. In order to indicate ANS status the effects of these stimuli were evaluated by FFD values and a kinetic record of changes in HR. Results: Both groups showed improvement in FFD values, which was the same as the results for AT via modification of ANS. However, changes in HR showed a different pattern from AT; in this study sympathetic nerve) dominantly showed an increase without a decrease in parasympathetic nerve. Discussion and Conclusions: The reasons for differences in ANS modification may be found in the role, especially in an emergency, of the lower body. The lower body is heavy in skeletal muscles, which needs energy and blood to react during acute stress. The ANS, which controls blood distribution, may shift and concentrate system blood from the smooth muscles of the stomach (controlled by parasympathetic nerve) to the skeletal muscles of the legs and feet (controlled by sympathetic nerve). Thus, this study indicated that local stimuli of the foot induced systematic ANS modification.

Objective: We investigated the effects and the mechanism of the acupuncture. Methods: Nishijo/Mori and colleagues studied the function of the autonomic nervous system (ANS) with the instantaneous heart rate (IHR) as indicator. With the ANS blockers we also revealed the response of ANS when we insert needles to human body. For example, in our study of 1991, we conducted an experimental study on humans and elucidated that the physical stimulation promoted the resilience and the homeostasis of our body. Our recent study (2013) showed the physical stimulation (not acupuncture) on the lower thighs (mainly the bottom of the feet) also enhanced the above mentioned effects. Results and Discussion: 1.　The subjects sat on the chairs and they were given the acupuncture stimulation on their wrists (the skin and subcutaneous tissues) at the expiration. The stimulation for the duration of 15 consecutive breaths increased the function of the parasympathetic nerve (PN). At the same time that of the sympathetic nerve (SN) also enhanced. In short, firstly that of PN enhanced and secondly that of SN followed. Thus, it was observed that the physical stimulations promoted the resilience and the homeostasis of our body and we may regard that this is the first mechanisms. 2.　In our recent study (2013) the subjects sat on the chairs and there were given the stimulation (50 times of fist-strikes) on the sole of the feet. Immediately after the stimulation the result of Floor Finger Distance test （FFD) was improved. At the same time IHR, the indicator of the function of ANS, showed that those of SN (adrenaline β stimulus) and PN were simultaneously increased as soon as the stimulation started. The same result was obtained from the study of the body vibration (the SOUND healing). This process of 2013 was different from that of 1991, however, both of them provided the effect; the promotion of the resilience and the homeostasis of our body. Therefore, we could regard it as the second mechanism of the physical stimulations which promotes the resilience and the homeostasis of our body. Conclusion: In this way, there are two mechanisms of the physical stimulation in promoting the resilience and the homeostasis of our body.

Purpose  In a series of our recent studies, systematic mild hyperthermia treatments, such as sauna, hot spring and a special bath for medical treatment, were found to activate leucocytes and to enhance immunity. Although they are known to be effective for health promotion, it is not easy for general people to regularly take these conventional hyperthermia. It would be advantageous for elderly persons, sick people and pregnant women as well as pressed business persons if it is able to minimize stress which might be induced by the conventional hyperthermia, such as high temperature heat, water pressure and humidity. To pursue a further study of the effect of hyperthermia itself, in this research, we utilized nano-mist sauna (NMS), a new hyperthermia treatment. NMS, a new type sauna, is characterized by the ability to produce ultra small fog-shaped hot water called nano-mist, which hardly condenses dew. And we studied the effect of NMS on body temperature, leukocytes, autonomic nerve function and energy production. Method  We obtained peripheral blood from six healthy male volunteers (age, 46.5±8.5 years) before and after NMS hyperthermia (20min, 40°C, 100%RH) for lactate and blood glucose measurement and flowcytometric analysis. Body temperature (hypoglossal) and pulse rates were also measured. The statistical analysis difference between the values was determined by paired t-test and Kruskal-Wallis test. Result  After NMS hyperthermia body temperature and the level of PO2 rose (36.8→37.2°C), (52→61mmHg) (p<0.05). On the other hand, the level of lactate showed decrease in all subjects. The ratio and the numbers of NK cells decreased (21.8→17.7%, 498→436/μL) (p<0.05) while those of B cells increased (9.5→12.1%, 261→349/μL) (p<0.05). Discussion  Several investigators report that the conventional hyperthermia enhances the primordial immune system (i.e. extrathymic T cells, NK cells, NKT cells and granulocytes) via dominance of sympathetic nerve system function (SNS) . Conversely, in our study, those of the conventional immune system (i.e. T and B cells) was enhanced, suggesting suppression of SNS function. It is reported that the expression level of HLA-DR on the B cells was elevated during hyperthermia (body temperature rose). SNS function (hypothermia) is stimulated by stress and it is suppressed by relaxing (hyperthermia) in the opposite. And it is considered that NMS hyperthermia suppressed SNS and that it was also consistent with our result of lactate decrease. It is possible to consider that NMS hyperthermia may impact on autonomic nerve activating leucocytes. Therefore NMS may be a kind of effective health promotion for valetudinarian (ie an infant, a female) and both a caregiver and a caretaker.

Objective:The aim of this study was to measure the value of over-the-counter (OTC) pravastatin as a healthcare-related item by investigating the public's willingness to pay(WTP)in self-medication for the primary prevention of myocardial infarction (MI)if pravastatin were switched to OTC status.
Methods:A questionnaire survey was distributed among those receiving health checkups at Kitasato Institute Hospital. For the WTP question format, the double-bound dichotomous choice approach was employed. Participants were randomly assigned to three groups. Group A was provided with a starting price per month of \5,000, group B with \8,000, and group C with \12,000. To investigate factors affecting WTP, Weibull regression analysis was used.
Results:The questionnaire survey was completed by 242 individuals(150 men, age range 30-82 years), and the mean WTP was \9,583 per month. Weibull regression analysis showed that age significantly affected WTP. The monthly cost for a physician consultation to receive prescribed pravastatin is \3,540 to \6,590 in the Japanese health insurance system.
Conclusion:The WTP was about \10,000 per month, and the WTP based on the questionnaire responses was more than two-fold higher than the present cost for a physician visit. This study clarified the WTP if pravastatin for the primary prevention of MI were switched to OTC status. Further studies are necessary to elucidate whether this would contribute to the promotion of self-medication among Japanese.

OBJECTIVESThe aim of this study is to examine the utilities of antenatal care with comprehensive health education qualified in Phnom Penh for the health of mothers and infants during perinatal and postpartum periods. Attention was given to the existing socioeconomic disparties among women in this urban area, and the utilities were discussed irrespective of socioeconomic status.

METHODSA total of 436 pregnant women in an urban area in Phnom Penh were selected using a complete survey in randomly sampled villages and were followed up. Participating in antenatal care with comprehensive health education at least three time was regarded as the use of "qualified antenatal care" during pregnancy. In this study, we investigated the independent associations of the use of qualified antenatal care with the following outcome variables after the adjustment for the influence of socieconomic variables: postpartum maternal health knowledge, postpartum maternal anemia, low birth weight, and infant immunization.

RESULTSOf the 314 subjects who completed the follow-up examination, 66.8% used qualified antenatal care during pregnancy. The use of qualified antenatal care was positively associated with postpartum maternal health knowledge (OR=2.38, 95% CI: 1.12-5.05). and reductions in the incidences of postpartum anemia (OR=0.22,95% CI: 0.05-0.95) and low birth weight (OR=0.05,95% CI: 0.01-0.39) after the adjustment of the influence of socioeconomic status. The infants born to mothers who used qualified antenatal care had significantly higher coverage of BCG, DPT(1), and DTP(3) immunizations (P<0.001,P<0.001, andP<0.01, respectively), independent of their socioeconomic conditions.

CONCLUSIONThis study shows the solid utilities of qualified antenatal care in Phnom Penh for perinatal health.