Background/Aims: The necessity for pharyngeal anesthesia during upper gastrointestinal endoscopy is controversial. This study aimed to compare the observation ability with and without pharyngeal anesthesia under midazolam sedation. Methods: This prospective, single-blinded, randomized study included 500 patients who underwent transoral upper gastrointestinal endoscopy under intravenous midazolam sedation. Patients were randomly allocated to pharyngeal anesthesia: PA+ or PA– groups (250 patients/group). The endoscopists obtained 10 images of the oropharynx and hypopharynx. The primary outcome was the non-inferiority of the PA– group in terms of the pharyngeal observation success rate. Results: The pharyngeal observation success rates in the pharyngeal anesthesia with and without (PA+ and PA–) groups were 84.0% and 72.0%, respectively. The PA– group was inferior (p=0.707, non-inferiority) to the PA+ group in terms of observable parts (8.33 vs. 8.86, p=0.006), time (67.2 vs. 58.2 seconds, p=0.001), and pain (1.21±2.37 vs. 0.68±1.78, p=0.004, 0–10 point visual analog scale). Suitable quality images of the posterior wall of the oropharynx, vocal fold, and pyriform sinus were inferior in the PA– group. Subgroup analysis showed a higher sedation level (Ramsay score ≥5) with almost no differences in the pharyngeal observation success rate between the groups. Conclusions Non-pharyngeal anesthesia showed no non-inferiority in pharyngeal observation ability. Pharyngeal anesthesia may improve pharyngeal observation ability in the hypopharynx and reduce pain. However, deeper anesthesia may reduce this difference.

BACKGROUND: Mizoribine (MZR) is an immunosuppressive drug used in Japan for treating patients with lupus nephritis and nephrotic syndrome and has been also reportedly effective in patients with immunoglobulin A (IgA) nephropathy. However, to date, few randomized control studies of MZR are performed in patients with IgA nephropathy. Therefore, this prospective, open-label, randomized, controlled trial aimed to investigate the efficacy and safety of adding MZR to standard treatment in these patients, and was conducted between April 1, 2009, and March 31, 2016, as a multicenter study. METHODS: Patients were randomly assigned (1:1) to receiving standard treatment plus MZR (MZR group) or standard treatment (control group). MZR was administered orally at a dose of 150 mg once daily for 12 months. RESULTS: Primary outcomes were the percentage reduction in urinary protein excretion from baseline and the rate of patients with hematuria disappearance 36 months after study initiation. Secondary outcomes were the rate of patients with proteinuria disappearance, clinical remission rate, absolute changes in estimated glomerular filtration rate from baseline, and the change in daily dose of prednisolone. Forty-two patients were randomly assigned to MZR (n = 21) and control groups (n = 21). Nine patients in MZR group and 15 patients in the control group completed the study. No significant differences were observed between the two groups with respect to primary and secondary outcomes. CONCLUSION: The addition of MZR to standard treatment has no beneficial effect on reducing urinary protein excretion and hematuria when treating patients with IgA nephropathy.
Glomerular Filtration Rate ; Glomerulonephritis, IGA* ; Hematuria ; Humans ; Immunoglobulin A* ; Immunoglobulins* ; Japan ; Lupus Nephritis ; Nephrotic Syndrome ; Prednisolone ; Prospective Studies ; Proteinuria

OBJECTIVEHie (cold sensation) is one of the most common health complaints in Japan. Those who suffer from severe hie are considered as having hiesho (cold disorder). However, exact hiesho symptoms have not been defined clearly and the decision as to whether a person suffers from hiesho is subjective and based on self-awareness. The study was conducted in attempt to develop a standardized hiesho diagnostic scale.

METHODSSubjects comprised 1 146 students. From the self-awareness of hiesho symptoms, males and females were divided into hiesho and non-hiesho groups. Physical, behavioral and adaptive characteristics were compared using the 24-item questionnaire (four-grade survey) and indicators for hiesho symptoms were extracted. Based on the scores, a receiver operating characteristic curve was drawn for the total ordinal scale score of the extracted items in relation to the presence and absence of hiesho symptoms, and an optimal cutoff value was determined.

RESULTSThe self-awareness of having hiesho was found in 23.2% males and in 55.6% females. The sensitivity was 84.5% for males and 83.3% for females in the hiesho groups, and the specificity was 86.0% for males and 85.2% for females in the non-hiesho groups.

CONCLUSIONA questionnaire consisting of the extracted items may be useful to identify hiesho in young males and females with a high level of accuracy.

[Introduction]Insomnia and anxiety are major symptoms of depression and severely limit the daily activities of depressed patients. We report the case of a depressed patient who had developed liver dysfunction caused by medication and whose depression was successfully managed by acupuncture after discontinuation of antidepressants.
[Case]A 37 years-old male had been taking noradrenergic and specific serotonergic antidepressant (NaSSA) and Chai Fu Jia Long Gu Mu Li Tang Jia Wei Gui pi Tang for insomnia and anxiety due to depression. Although his symptoms had improved by the medication, abnormalities in his liver functions were found after 3months of medication. After he was diagnosed as having drug-induced liver damage, he was admitted to Meiji University's Integrative Medicine Hospital and all medication was replaced by Glycyrrhizin and Glutathione. Consequently his depression and symptoms returned. We then tried to relieve his symptoms by applying acupuncture, which was prescribed according to traditional Chinese medical diagnosis (TCM diagnosis, Heart Yin Deficiency , Liver Qi Stagnation , and Kidney Yin Deficiency ).
[Results]After 4 acupuncture treatments, the patient's duration and depth of sleep considerably improved compared with that before the acupuncture sessions, and comparable results were maintained until discharge. Beck Depression Inventory (BDI) scores were also markedly improved from 'moderate depression'(24 points) at the beginning of treatment to 'minimal depression'(8 points) at the end (9th treatment, 16 days from the first session).
[Conclusion]The results of this case suggest that acupuncture treatment may be an effective alternative for anti-depressants when there is a limitation to administer those drugs.

Objective: We examined the effects of low frequency electro-acupuncture therapy (EAT) in young women with‘Hie’symptoms, which were classified according to the presence of the vasomotor dysfunction as determined by the postural change test. Subjects and Methods: Subjects were 43 women (mean age, 21.2 years) who exhibited‘Hie’symptoms. The postural change test was performed in five-minute-loads in a standing position after a rest period of 10 minutes in a spine position. The skin temperature in the lower limbs was measured before and after the test. A stainless steel acupuncture needle (length, 40 mm; diameter, 0.2 mm) was inserted approximately 15 mm in depth at SP6 (Sanyinjiao, Saninko). EAT using an active electrode (needle) at SP6 and a reference electrode (surface electrode) at the lateral-anterior aspect of the lower leg were carried out at a frequency of 1 Hz for 20 minutes. The therapy was provided in a total of 5 sessions, with 1 session per week, and the postural change test was performed after 5 sessions. Thermal images from the medial aspect of the foot to the tibial aspect of the lower leg were captured using a thermography device, and mean skin temperature was calculated in selected regions of the toes and tibial aspect of the lower leg. Effects of the therapy were also evaluated using an original questionnaire (‘Hie’diary) concerning‘Hie’symptoms, which consists of six categorical scales of 14 symptoms including‘Hie’and severity of‘Hie’on a Visual Analogue Scale (VAS) was used. Moreover, changes in health-related quality of life by acupuncture were evaluated using the SF-8 Standard Edition. Results: Subjects were classified according to the results of the postural change test: 23 people (no vasomotor dysfunction group; non-vd group) whose skin temperature in the toe decreased after the postural change and 20 people (vasomotor dysfunction group; vd group) whose skin temperature in the toe increased after the load or showed a different reaction between right and left. In the vd group, the total score of 14 symptoms in the‘Hie’diary was significantly higher, and subjective‘Hie’symptoms showed a more severe score than that in the non-vd group. The bodily pain score in the SF-8 in vd group was significantly lower than a national reference value. After an EAT session, the vd group’s skin temperature on the tibial aspect of the lower leg at 20 minutes after completion of the load was significantly higher than that before the load. Moreover, changes in the VAS score and SF-8 score showed no statistical significant in both groups, but the total score of 14 symptoms decreased significantly in the vd group. Conclusions: We suggested that normalization in the blood vessel reaction in lower limbs by EAT at SP6 contributed to the improvement in the systemic condition that was determined by the postural test. The issue of further investigation is to elucidate the pathogenesis andor establishment of the treatment in the subjects with‘Hie’symptom whose vasomotor function was within normal limits.

Objective  We examined the effects of low frequency electro-acupuncture therapy (EAT) on young women who suffered from‘Hie’symptoms, which were judged according to the national normal value of bodily pain (BP) scores from a ”Medical Outcomes Study Short-Form-8 Survey“ (SF-8). Subjects and Methodology  The experimental subjects were 20 women (mean age: 21.2 years old; range: 18-26 years old) who exhibited symptoms of ‘Hie’ symptoms (vasomotor dysfunction) and whose toes’skin temperature increased or showed a different reaction between right and left during a postural change test. A stainless steel acupuncture needle (length: 40 mm; diameter: 0.2 mm) was inserted approximately 15 mm deep at SP6 (Sanyinjiao, Saninko). EAT using an active electrode (the needle) at SP6 and a reference electrode (surface electrode) at the lateral-anterior aspect of the lower leg was applied at a frequency of 1 Hz for 20 minutes. The therapy was provided one session per week for a total of five sessions. Effects of the therapy were evaluated by using an original questionnaire (‘Hie’diary), which consisted of six categorical of 14 symptoms (including of‘Hie’) and Visual Analogue Scale (VAS) of‘severity of Hie’. Moreover, changes in health-related quality of life (HRQOL) by acupuncture were evaluated by using the SF-8 Standard Edition. Results  Subjects were grouped according to their SF-8 BP scores before the therapy: 12 subjects (L group) whose scores were less than the national normal value (42.75 points), and eight subjects (H group) whose scores were more than the national normal value. For both groups VAS levels showed no statistically significant changes, but for the L group the total score of 14 symptoms significantly decreased after the second therapy session compared with scores before the therapy. Moreover, the statistically significant decrease in the total score lasted for one month after the therapy had been finished. Compared with before therapy, the score of ‘vitality’ (VT) significantly increased for the L group one month after the therapy, and those of BP and ‘mental health’ (MH) significantly increased for the L group just after and one month after the therapy. Conclusions  EAT at SP6 on young women with ‘Hie’ symptoms (vasomotor dysfunction) contributes to improvement in overall condition and health-related QOL, and it is occluded that the effect of the EAT was high, because HRQOL was low (the score of BP was low).

Pneumonia is one of major causes of cough, which sometimes resists medication and remarkably deteriorates QOL of the patient. We report a case of pneumonia in a person suffering from severe cough and pain in the general body accompanied by cough for which conventional medication did not work but was improved by acupuncture treatment.
A 47-year-old woman was diagnosed by her physician with pneumonia on August 2, 200X. Although antibiotics were administered, her symptoms were not improved. She visited Meiji University of Integrative Medicine Hospital and was hospitalized on the same day. Despite strict medication with antibiotics, antitussive agent and expectorant during hospitalization, her severe cough and body pain remained unchanged.
Acupuncture treatment was then started on August 7. The basic meridian points used were LU1 (Zhongfu), LU5 (Chize), BL13(Feishu), LU7 (Leique), LI4 (Hegu), GB20 (Fengchi), GB14 (Danzhui), ST12 (Quepen), ST11 (Qishe), and CV22 (Tiantu). The acupuncture needles were retained for ten minutes at these points in each session. After ten acupuncture treatments for over seven days, the VAS for body pain accompanied by cough showed a remarkable improvement. Also, significant relief in cough was observed every time immediately after treatment.
We suggested that acupuncture treatment might be useful for cough and/or pain in the body accompanied by cough in a patient with pneumonia.

Objective
 We examined the effects of acupuncture electrotherapy in young women with hie symptoms (excessive sensitivity to cold), presented in conjunction with vasomotor dysfunction as determined by the postural change test.
Subjects and Methods
 Subjects comprised 20 women (mean age, 20.6 years; range, 18-26 years) who exhibited symptoms of hie, evaluated as toe skin temperature after standing for 5 mins or a temperature difference between the right and left toes as compared to before standing. A stainless steel acupuncture needle (length, 40 mm; diameter, 0.2 mm) was inserted approximately 15 mm in SP6 (Shangqui). Acupuncture electrotherapy connected an acupuncture electrode to SP6 and a non-feeling electrode to lateral of the tibial tuberosity, and was undertaken at a frequency of 1 Hz for 20 mins. Therapy was provided as a total of 5 sessions, with 1 session each week, and the postural change test was performed before and after therapy. Thermal images from the medial aspect of the foot to the tibial aspect of the lower leg were captured using a medical thermography device, and mean skin temperature was calculated in selected regions of the toes, metatarsals, ankle, and tibial aspect of the lower leg. Therapy was evaluated using a questionnaire with two originally designed scales: a categorical scale of 14 symptoms including hie; and degree of hie on a visual analogue scale (VAS). Subjects completed the questionnaire every day during a period from 1 week before therapy sessions began until 1 week after completion of all 5 sessions. Scores for hie symptoms were calculated as mean values from the total score of the 14 symptoms and VAS each week. Changes in health-related quality of life with acupuncture were evaluated using the SF-8 Standard Edition.
Results
 Toe skin temperature just after standing was not significantly increased by therapy as compared to before standing. Skin temperature on the tibial aspect of the lower leg 20 mins after standing was significantly increased as compared to the adaptation period. In terms of hie, VAS and SF-8, no significant changes were seen before and after therapy, but total score for the 14 symptoms decreased significantly.
Conclusions
 Acupuncture electrotherapy to SP 6 did not appear to exacerbate hie symptoms after reductions in air temperature, while normalizing the postural vascular reflex and improving hie-related symptoms.

[Background]Functional abdominal pain syndrome (FAPS) represents a chronic pain disorder localized in the abdomen and the symptoms largely are unrelated to food intake and defecation, which differ from other painful functional gastrointestinal disorders.
We report a case of FAPS whose symptom was successfully improved by acupuncture.
[Case Report]A 75-year-old female had been hospitalized at Meiji University of Integrative Medicine Hospital because of left lower abdominal pain from which she had repeatedly suffered for more than 2 years. Despite strict medication, her symptom had not been improved. After admission to the hospital, according to recommendation by her physician, acupuncture treatment was started. The patient received TCM-based acupuncture treatments five times a week over 13weeks. Primary acupuncture points used for the patient were LV3(Taichong), SP6 (Sanyinjiao), ST36 (Zusanli) and PC6 (Neiguan). Evaluation of the left lower abdominal pain was carried out with a Visual Analogue Scale (VAS). The Gastrointestinal Symptom Rating Scale (GSRS) was used to evaluate QOL related to the digestive symptoms. VAS for the left lower abdominal pain showed a remarkable decrease immediately after the initial acupuncture session. The symptom disappeared within 4 weeks after commencement of the treatment and never appeared during her hospitalization. GSRS was also improved and it was maintained during hospitalization.
[Conclusion]We suggested that acupuncture treatment might be one of the useful, non-pharmacological alternatives for symptoms of FAPS.