浅谈古今医家对二间穴临床应用的认识

论述古今医家对二间穴临床应用的认识。古代医家多用于治疗咽喉肿痛、牙痛、面痛,现代医家拓宽了二间穴的主治内容,常用于治疗肩周炎、膝关节痛、胃痛、麦粒肿。     

A consideration of the operation of automatic production machines

At worksites, various automatic production machines are in use to release workers from muscular labor or labor in the detrimental environment. On the other hand, a large number of industrial accidents have been caused by automatic production machines. In view of this, this paper considers the operation of automatic production machines from the viewpoint of accident prevention, and points out two types of machine operation − operation for which quick performance is required (operation that is not permitted to be delayed) − and operation for which composed performance is required (operation that is not permitted to be performed in haste). These operations are distinguished by operation buttons of suitable colors and shapes. This paper shows that these characteristics are evaluated as “asymmetric on the time-axis”. Here, in order for workers to accept the risk of automatic production machines, it is preconditioned in general that harm should be sufficiently small or avoidance of harm is easy. In this connection, this paper shows the possibility of facilitating the acceptance of the risk of automatic production machines by enhancing the asymmetric on the time-axis.     

Effects of α1‐Blockers for Lower Urinary Tract Symptoms and Sleep Disorders in Patients with Benign Prostatic Hyperplasia

Objectives: We evaluated the association of lower urinary tract symptoms (LUTS) and sleep disorders (SD) in patients with benign prostatic hyperplasia (BPH). We also examined improvement of SD following the α1‐blocker therapy for LUTS. Methods: Sixty‐eight male patients were enrolled in the study, consisting of 38 cases with LUTS and BPH (BPH group), and 30 men without significant LUTS or BPH (non‐BPH group). The degree of LUTS and SD was evaluated by the International Prostate Symptom Score and the Pittsburg Sleep Quality Index (PSQI), respectively. The patients of BPH group then were treated with α1‐blocker for 4 weeks, and were re‐examined by all the questionnaires to evaluate the therapeutic efficacies. Results: The correlation analyses showed a significant association of LUTS with SD in BPH group (r = 0.4995, P = 0.0068). Twenty cases (52.6%) in BPH group showed 5.5 or more PSQI scores. Following 4 weeks of α1‐blocker administration, the average PSQI decreased significantly from 6.3 to 4.8 points (P < 0.001). Significant improvement was observed in domains of “sleep quality” and “sleep disturbances” among PSQI (P = 0.0215 and 0.0391, respectively). Moreover, significant association between α1‐blocker induced improvements of nocturia and SD was identified in patients with 5.5 or more PSQI score at baseline (r = 0.445, P = 0.0334). Conclusion: These results suggested that SD is associated with LUTS among BPH patients and therapeutic effects of α1‐blockers on LUTS lead to improvements of SD.     

Summation of Excitation with a Single Conditioning Stimulus in the Canine Heart

A subthreshold stimulus was reported to become effective in producing a propagated ventricular response when preceded by another subthreshold stimulus or stimuli, a phenomenon that is known as summation of excitation but has not been studied systematically. Effect on summation of current intensity and coupling interval of a conditioning stimulus (Sc, protocol #1) and that of stimulation site of Sc (protocol #2) were determined in anesthetized, open-chest dogs. Effective refractory period (ERP) was determined with an extrastimulus (S2) at a ventricular pacing cycle length (S1S1) of 500 msec. Pulse width of S1, S2 and Sc was 2 msec. For pacing protocol #1 (12 dogs), current intensity of S1 and S2 was equal (twice diastolic threshold, 2, 5, or 15 mA), and that of Sc was equal to or lower than that of S1. S1S2 interval was fixed 1 msec shorter than ERP, and Sc was delivered 5 msec prior to S2. The S1Sc interval was shortened in 2 msec steps. Summation was present if Sc plus S2 evoked a propagated response. Prevalence of summation increased along with an increase in current intensity of Sc (P less than 0.01). For pacing protocol #2 (7 dogs), current intensity of S1, S2 and Sc was equal (twice diastolic threshold, 5 or 10 mA). As the distance between site of Sc and that of S2 increased, prevalence of summation decreased (P less than 0.01). Summation did not occur when Sc was delivered at a site only 5 mm away from the site of S2. In conclusion, summation of excitation with a single conditioning stimulus was both time and strength dependent, and limited in development spatially.     

Clinical Features of Congenital Ankylosis of the Digital Joints of the Hand

ABSTRACT: Clinical features and roentgenographic findings of 37 patients (65 hands) with congenital ankylosis of the digital joints, including symphalangism and other types of congenital ankylosis of the joints, were analyzed. Congenital ankylosis of the digital joints was divided into four types according to the clinical features as follows; Type A (typical symphalangism), 13 cases, Type B (symphalangism without associated anomalies), 6 cases, Type C (symphalangism associated with hypoplasia of the affected digit), 10 cases and Type D (symphalangism as a part of syndrome), 8 cases. Roentgenographic findings of the affected joints were divided into 4 types, such as normal type (Type I), narrow type (Type 2), flat type (Type 3) and bony ankylosis (Type 4). There seems to be 4 types of joint development in congenital ankylosis of the digital joints. In Types 1 and 2, the joint space of the affected joint and the secondary ossification center looks normal. The joint seems to develop normally in Type 1, but the condyle of the affected joint becomes flat in Type 2. In Type 3, the joint space is narrow in infancy, the secondary ossification center fuses with the proximally located phalanx and finally the affected joint develops bony ankylosis. In Type 4, there is osseous fusion of the affected joint at birth. Key words: hand, joint, symphalangism, tarsal coalition, carpal coalition     

Six month outcomes of an innovative weekly intergenerational day program with older adults and school‐aged children in a Japanese urban community

Aim: To describe the nature of the progression of intergenerational interactions among and between older people and children in a weekly intergenerational day program (IDP) in an urban community and to evaluate the older people's health‐related quality of life (HRQOL) and depressive symptoms, compared to the program volunteers, as well as the children's perspectives of older people, during the first 6 months of the program's implementation. Methods: This longitudinal study, with a convenience sample of older people (n = 14), program volunteers (n = 8), and school‐aged children (n = 7), used mixed methods to analyze the results. Participant observations and interviews were used to describe the interactions between the generations over the 6 months. An ANOVA with repeated measures was used to determine the statistical effects over time (initially and at 3 months and 6 months) for HRQOL (Medical Outcomes Study 8‐Item Short‐Form Health Survey) and depression (Geriatric Depression Scale, GDS‐15). Semantic differential scales identified the children's perspectives of older people. Results: The intergenerational interactions were grouped into thirteen categories; for example, “The IDP provided a meaningful sense of place.” The quality of life in relation to the mental health of the older people's group improved significantly between the first involvement and after 6 months, while the GDS‐15 scores significantly decreased at the three time points in the more depressed older people's subgroup. The children's initial generally positive perspectives of older people showed no statistically significant change over time. Conclusion: The intergenerational interactions in the IDP yielded a meaningful place for both generations, improved the HRQOL of the older people's group, and decreased the depressive symptoms in the more depressed older people's subgroup.     

Efficacy of Ramelteon in Patients with Insomnia and Nocturia

Objectives: To study the efficacy of ramelteon for patients with insomnia and nocturia. Methods: Forty‐nine patients experiencing insomnia and two or more nocturnal voids were included. The degree of lower urinary tract symptoms and sleep disorders was evaluated using the International Prostate Symptom Score (IPSS), Pittsburg Sleep Quality Index (PSQI) 1 score, and frequency/volume chart (FVC). The patients were treated with ramelteon (8 mg) for four weeks and then reexamined by questionnaire and FVC to evaluate the therapeutic efficacies. Results: The mean IPSS score was 16.1 ± 6.9 at baseline and 12.4 ± 7.1 at four weeks. The subject scores for the number of nocturnal voids also decreased significantly from 3.3 ± 0.9 to 2.9 ± 1.0. In addition, PSQI scores improved significantly from 7.4 ± 2.9 to 5.4 ± 2.8. According to the FVC, the number of nocturnal voids decreased significantly from 3.1 ± 1.2 at baseline to 2.2 ± 1.1 at four weeks, and nighttime bladder capacity improved significantly from 181.4 ± 79.9 to 201.1 ± 93.7 mL. Conclusion: Ramelteon alleviated nocturia and disturbed sleep in patients with insomnia and nocturia and led to increased nighttime bladder capacity.     

Serum pancreatic secretory trypsin inhibitor in pancreatic diseases

To elucidate the diagnostic significance of serum pancreatic secretory trypsin inhibitor (PSTI) in pancreatic diseases, organ distribution of PSTI and abnormalities in serum PSTI were studied. The pancreas showed the highest content of PSTI, which was five times that of the stomach and almost 40 times that of the other organs. Serum PSTI and amylase were elevated in eight patients with acute pancreatitis, 27 and 11 patients of 47 with chronic pancreatitis, 31 and 13 of 36 with pancreatic cancer, and 67 and 62 of 109 with non-pancreatic disease, respectively. PSTI levels were more sensitive to the presence of pancreatic disease than were amylase levels. The specificities in serum of healthy controls and patients with non-pancreatic disease were similar for PSTI and amylase (69% vs 71%). In chronic pancreatitis and pancreatic cancer patients the efficiency of the PSTI assay was higher (P < 0.02) than the amylase assay (67% vs 63% for pancreatitis and 71% vs 66% for cancer). The sensitivity and efficiency of serum PSTI assay in chronic pancreatic diseases were superior to those of amylase.     

Age-related profile of neuroblastoma: A comparison of tumors detected by mass-screening with those detected clinically

Infants with neuroblastoma are known to have a favorable prognosis compared to those over 1 year of age. However, there is little biological information about the age-related heterogeneity of neuroblastoma. We evaluated the biological profile comparing cases detected by mass screening with those detected clinically. A total of 238 patients with neuroblastoma were classified into four groups according to their age at diagnosis. Patients in group A were 0–5 months of age (n = 31). Patients in group B were detected clinically and were 6–11 months of age (n = 25). Patients in group C were 6–11 months of age and were detected by mass-screening (n = 97). Patients in group D were more than 12 months of age (n = 85). The age-related heterogeneity was evaluated by Kaplan-Meier survival analysis, several clinical markers (neuron specific enolase, ferritin, vanillylmandelic acid and homovanillic acid) at diagnosis, tumor Ha-ras p21 expression and tumor N-myc amplification. Infant neuroblastoma had unique features in comparison to neuroblastoma diagnosed over 12 months of age. Clinical outcome of the patients in groups A and C was quite favorable. Even patients with stage III or IV disease in group A had a favorable prognosis. However, stage IVs disease in group A was not necessarily associated with a good prognosis and the early death after diagnosis was also characteristic. The biological profile of tumors in group C was similar to that in group A but different from the profile in groups B and D. Tumors in group B had a biological profile intermediate between groups A and D. Cases detected by mass screening (group C) provided a new clinical entity with a good prognosis. The difference in biological profiles might affect their clinical outcome of respective age group. These analyses confirm the significance of prognostic markers and may help to direct an appropriate modality of treatment for the individual patient.