A Case of Recurrent Nausea with Vomiting for Past Sixteen Years Successfully Treated with a Kampo Formulation Shimbuto / 日本東洋医学雑誌

We herein report a 36-year-old male patient, who complained of persistent and recurrent nausea with vomiting for 16 years in spite of various standard treatments, was successfully treated with Kampo formulation Shimbuto, which selected based on the left para-navel tender point. We speculated that the clinical disorder in this case was related to suitai i.e. water imbalance syndrome in Kampo medicine. However, there has never been such a case report in the field of Kampo, and no related papers have been found in the standard database Medline. We believe this report is valuable from the viewpoint of therapeutics in both Western and Kampo medicine.

Three Cases of Febrile Diseases Successfully Treated with a Kampo Formulation Shimbuto / 日本東洋医学雑誌

We herein report three patients who complained atypical febrile diseases associated with painful whole body (Case 1), general fatigue (Case 2), and a sense of general discomfort (Case 3). All cases were not accompanied by dizziness and a shaky feeling which are commonly associated in shimbuto-sho i.e. indication of shimbuto, but presented severe tenderness at the left paraumbilical region which was suggested as indicative point of shimbuto by Yoshiko Takagi. We made a diagnosis in these three cases as shimbuto-sho based on the Takagi's tender point. Through these clinical experiences we propose that a new type of shimbuto-sho, which are completely different from the fixed idea of inherited knowledge. This new type of shimbuto-sho consists of following signs ; fever with chill, floating and feeble pulse, no sweating, general fatigue or body pain, and severe pain at Takagi's tender point.

A utilização das abordagens renovadoras em concursos públicos para a Educação Física no município do Rio de Janeiro / The use of renewing approaches in public tenders for Physical Education in the municipality of Rio de Janeiro / El uso de enfoques renovadores en licitaciones públicas para Educación Física en el municipio de Rio de Janeiro

Procuramos compreender a relação das referências de concursos públicos para escolas que tenham unidades no município do Rio de Janeiro. Tratou-se de um estudo de tipo transversal, por analisar um ponto específico num dado momento, desenvolvido por levantamento de dados e questionário em uma perspectiva qualitativa. Apresentamos, através do levantamento bibliográfico, quais são as referências mais usadas nos últimos dez anos e relacionamos, através do questionário fechado, como os professores de Educação Física entendem a importância das abordagens e o que de fato utilizam. Para auxiliar na reflexão sobre o questionário utilizamos o tipo-ideal weberiano. Mais da metade da literatura utilizada em concursos públicos no Rio de Janeiro que tenham escolas no município, exigem que seus professores, ao fazerem o concurso, dominem as Abordagens Renovadoras. Concluímos que, ainda que confusas, as abordagens aparecem no discurso dos participantes, principalmente aquelas que se relacionam direto com os PCN e com a Psicomotricidade.

We seek to understand the relationship between the references of public tenders for schools that have units in the Rio de Janeiro. It was a cross-sectional study developed by data collection and questionnaire in a qualitative perspective. We present, through the bibliographic survey, which are the most used references in the last ten years and relate, through the closed questionnaire, how Physical Education teachers understand the importance of the approaches and what they actually use. To help reflect on the questionnaire, we used the ideal Weberian type. More than half of the literature used in public tenders in Rio de Janeiro that have schools in the municipality, require that their teachers, when making the contest, master the Renovatory Approaches. We conclude that, although confusing, the approaches appear in the participants' discourse, especially those that are directly related to the PCN and Psychomotricity.

Buscamos comprender la relación entre las referencias de licitaciones públicas para escuelas que tienen unidades en el municipio de Rio de Janeiro. Fue un estudio transversal, ya que analizó un punto específico en un momento dado, desarrollado a través de la recopilación de datos y un cuestionario en una perspectiva cualitativa. Presentamos, a través de la encuesta bibliográfica, cuáles son las referencias más utilizadas en los últimos diez años y relatamos, a través del cuestionario cerrado, cómo los maestros de Educación Física entienden la importancia de los enfoques y lo que realmente usan. Para ayudar a reflexionar sobre el cuestionario, utilizamos el tipo Weberian ideal. Más de la mitad de la literatura utilizada en licitaciones públicas en Río de Janeiro que tienen escuelas en el municipio, requieren que sus maestros, al realizar el concurso, dominen los enfoques renovadores. Llegamos a la conclusión de que, aunque confusos, los enfoques aparecen en el discurso de los participantes, especialmente aquellos que están directamente relacionados con el PCN y la psicomotricidad.

Clinical profile and outcome of scar endometriosis in a tertiary care centre of Northern India

Background: Endometriosis is defined as the presence and proliferation of the endometrium outside the uterine cavity affecting an estimated 89 million women of reproductive age worldwide. Endometriosis occurs in 5% to 10% of all women, often resulting in debilitating pain and infertility, endometriosis at the scar site known as Scar endometriosis has also been described following obstetrical and gynecological surgery. Scar endometriosis has a much rarer incidence with an illusive presentation and is often misdiagnosed and definitive treatment gets delayed. Objectives of this study was to review the demographic profile, clinical presentation, treatment modalities and outcome in patients with scar endometriosis.Methods: The retrospective study of patients with scar endometriosis managed at DMCH during January 2014 to December 2018 was done.Results: Eight patients of scar endometrosis were diagnosed and operated in our institution over a period of five years. All patients (six with previous caesarean section scar site and two at episiotomy site) presented with tender nodules with pain which got exaggerated during menstruation.Conclusions: A high index of suspicion of scar endometriosis should be kept in patients presented with cyclical pain and tender mass getting exaggerated during menstruation.

Comparison of therapeutic effect of soft-tissue relaxing needling and electroacupuncture for knee osteoarthritis / 针刺研究

OBJECTIVE: To compare the clinical efficacy of soft-tissue relaxing needling and electroacupuncture (EA) in the treatment of knee osteoarthritis (KOA), so as to explore a new and more effective therapy for KOA. METHODS: Forty patients with KOA who met our diagnostic criteria were randomly and equally divided into acupuncture group and soft-tissue relaxing needling (relaxing-needling) group. EA (20 Hz, a tolerable strength and duration of 20 min) was applied to the unilateral Neixiyan(EX-LE5) and Waixiyan(EX-LE5), and manual acupuncture stimulation was applied to Heding(EX-LE2), Xuehai (SP10), Xiyangguan (GB33), Liangqiu(ST34), Yanglingquan(GB34) and Yinlingquan(SP9) on the affected side by using uniform reinforcing-reducing technique. In the relaxing-needling group, after identifying the tender point and nodule-like or stiff-strip-muscle spot at the affected limb by palpation, we used filiform needles to insert into them, then, made a longitudinal separation or point-like pricking. The visual analog scale (VAS) pain score, knee flexion activity (range of motion, ROM), and the knee osteoarthritis severity (Lequesne index, composed of daily living, walking distance and pain) were measured before and after the treatment. The therapeutic effect was assessed by consulting the Guiding Principles for Researching New Drugs of Traditional Chinese Medicine (2002) and Criteria for Diagnosis and Assessment of Therapeutic Effect of Syndromes or Illnesses of Traditional Chinese Medicine (1994). RESULTS: After the treatment, the VAS score and Lequesne index were significantly decreased in both acupuncture and relaxing-needling groups (P0.05)．. CONCLUSION: Both relaxing-needling and EA therapies are comparable in the therapeutic effect for KOA, and the former is superior to the latter in reducing the joint pain and improving the knee joint locomotor function, thus being worthy of clinical application.

Two Cases of Mental Disorder with the Tender Point at the Left Paraumbilical Region two Fingerbreadths Away from the Umbilicus were Successfully Treated with Shimbuto / 日本東洋医学雑誌

Two cases of mental disorder with the tender point at the left paraumbilical region two fingerbreadths away from the umbilicus were successfully treated with shimbuto. These cases appeared shimbuto symptoms corresponding to the provisions of the early yang stage pattern and the middle yin stage pattern in the classic textbook ‘Shanhanglun'. The pathogenesis of these cases of the patients who improved with shimbuto would be qi and fluid intimidating. The tender point at the left paraumbilical region by palpation is considered as ‘Huangshu KI 16' of kidney meridian in ‘WHO Standard Acupuncture Point Locations in the Western Pacific Region'. This tender point is a very useful diagnostic sign to prescribe for simbuto. It suggests that an acupuncture point on the meridian and collateral theory might appear the condition of three yin and three yang disease in ‘Shanhanglun' and be useful to choose Kampo medicine.

Difference of alkaloid components between old stems and tender stems of Gelsemium elegans / 中国中药杂志

This study aimed to comprehensively assess the difference of alkaloid components between old stems and tender stems of Gelsemium elegans by using ultra high-performance liquid chromatography coupled with photo-diode array and quadrupole time-of-flight mass spectrometry( UPLC-Q-TOF/MS~E) and high-performance liquid chromatography coupled with UV detector( HPLC-UV). Firstly,the different components in old stems and tender stems were analyzed by UHPLC-Q-TOF/MSEcombined with principal component analysis( PCA) and orthogonal partial least squares discriminant analysis( OPLS-DA),respectively. As a result,17 major different components were found. At the same time,the distribution of these alkaloids in old stems and tender stems was determined,and the alkaloids with higher polarity are relatively higher in the tender stems,while the old stems are in the opposite case. In addition,three main components in the G. elegans were quantified by HPLC-UV. The results showed that the contents of koumine and humantenmine in old stems were higher than those in tender stems,and the content of gelsemine in tender stems was relatively high. This study systematically evaluated the differences of alkaloids between the old stems and tender stems of G. elegans,and quantified the main three alkaloids. It laid the foundation of the safe and effective application of G. elegans.

Evidence-based medicine research on low-back pain with sham-acupuncture controlled design and the analysis on dynamic acupoint positioning / 中国针灸

To explore the positioning of acupoints, a research was done with PubMed for system reviews and clinical trials on treatment of low-back pain with sham-acupuncture controlled design from January 1, 2010 to October 27, 2017. Six system reviews and 12 sham-controlled acupuncture random trials were found. The statistical difference was not found in all the 6 trials with standard acupoint compared with the sham-acupuncture among the 8 penetrating skin sham-control trials. The statistical difference was found in the two trials with penetrating skin sham control, who was used individualized treatment, twirling for arrival or palpation for point. It is considered that sham-acupuncture penetrating skin is not a placebo, and needling with standard or dynamic acupoint may reduce low-back pain, and dynamic acupoint positioning may be better than standard acupoint positioning.

Acupuncture Treatment of Primary Dysmenorrhea by Needling Acupoints of the Spleen Meridian with Positive Reactions：A Randomized Controlled Clinical Trial / 针刺研究

OBJECTIVE: To observe whether acupuncture of the tender-points of the Spleen Meridian can achieve a better therapeutic effect for primary dysmenorrhea (PD) patients, so as to verify the importance of examining meridian-acupoint reactions in clinical practice. METHODS: A total of 72 PD patients were randomly assigned to tender-point group (observation group) and regular acupoint group (control group, n＝36 in each). For patients of the observation group, the tender-points around San-yinjiao (SP 6), Diji (SP 8) and Yinlingquan (SP 9) were needled, and for those of the control group, the regular SP 6, SP 8 and SP 9 were needled. After "Deqi", the filiform needles were manipulated with lifting-thrusting reducing technique for about 30 s, repeated once again every 10 min during 30 min's needle retention, and the treatment was conducted once daily for 3 days during every menstrual cycle, continuously for 3 months. The visual analogue scale (VAS) was rated for assessing the pain severity, and the COX menstrual symptom scale (CMSS) consists of 17 items and 5 grades/item (0－4 points) according to the severity of discomfort was rated before and after the treatment. RESULTS: After the treatment, the VAS and CMSS scores on the 1st days of the 1st, 2nd and 3rd menstrual cycles were significantly decreased in both control and observation groups in comparison with their own individual pre-acupuncture (P0.05). CONCLUSION: Acupuncture stimulation of the tender points around the SP 6, SP 8 and SP 9 has a stronger analgesic effect relevant to needling the regular acupoints in PD patients.

Correlations of Eotaxin-1, rheumatoid factor and anti-cyclic citrullinated peptide antibody with the activity of rheumatoid arthritis / 临床检验杂志

Objective To investigate the correlations of Eotaxin-1,rheumatoid factor (RF) and anti-cyclic citrullinated peptide (CCP) antibody with the activity of rheumatoid arthritis (RA).Methods A total of 58 patients with early RA,46 patients without RA and 53 healthy controls from our hospital during December 2014 and December 2015 were enrolled in our study.The activity of RA was evaluated by the swollen joint count (SJC),tender joint count (TJC) and DAS28 score.The levels of serum Eotaxin-1 and antiCCP antibody were detected by ELISA and serum RF levels were determined by the immunological turbidimetry.The comparisons of serum Eotaxin-1,anti-CCP antibody and RF levels between different groups were performed with ANOVA and their correlations with SJC,TJC and DAS28 score were analyzed by Spearman rank correlation.Results The levels of Eotaxin-1,anti-CCP antibody and RF in RA patients were (96.02 ± 2 1.07) pg/mL,(183.42 ± 87.45) U/mL and (119.09 ± 62.30) RU/mL,respectively,which were significantly higher than those in the patients without RA and healthy controls (P ＜ 0.01).The levels of serum Eotaxin-1 in RA patients were significantly related to TJC,SJC and DAS28 score (P ＜ 0.01),while the levels of anti-CCP antibody were related to TJC and DAS28 score.The levels of RF were only related to DAS28 score.Conclusion The levels of serum Eotaxin-1 and anti-CCP antibody in RA patients are significantly correlated with the activity of RA,which may be new serum markers to monitor the activity of RA.

A Case of Trigeminal Neuralgia Effectively Treated with Jidabokuippo: Hint from Past Injury and Tender Point / 日本東洋医学雑誌

A thirty-eight-year old woman with facial pain was diagnosed with trigeminal neuralgia, and treated with conventional carbamazepine therapy. Although the pain was alleviated to a certain degree, she visited our clinic to receive Kampo therapy. Judging from her facial injury in an accident thirty years ago, jidabokuippo was administered in addition to carbamazepine. The trigeminal neuralgia was then relieved, and Takagi's tender point in her abdomen was also reduced or disappeared. She could finally stop carbamazepine therapy. This case suggests that neuralgia patients with previous injury and Takagi's tender point can be treated with jidabokuippo.

Discussing the relationship among thepoint, tender point and myofascial trigger point / 中国针灸

The conception and the history ofpoint, tender point and myofascial trigger point are described in the paper. All of three kinds of point are the reaction of musculoskeletal pain and visceral diseases. Theoretically,point originates from the theory of muscle region of meridian, tender point from the theory of soft tissue and muscles and myofascial trigger point from the theory of muscular fasciae. Anatomically,point is localized in the muscle region of meridian, on the boundary between muscles, tender point is on the muscular attachment to skeleton (the starting and ending points) and myofascial trigger point is on the motor point of neuromuscles. Pathologically,point reflects the disorders of soft tissue and internal organ, tender point reflects the disorders of soft tissue and myofascial trigger point reflects the disorders of soft tissue and few disorders of internal organ. To identify the relationship among them is very significant in the target treatment with acupuncture.

Using fine management to improve the quality of application documents of grants from National Natural Science Foundation of China / 中华医学科研管理杂志

The key point of successful National Natural Science Foundation of China (NSFC) grant application is to improve the quality of application documents.This article analyzed the application and approval of Natural Science Foundation of China in the Second Affiliated Hospital of Wenzhou Medical University in the recent five years.To explore the method through applying fine management to improve the quality of application documents,which include many useful hints,such as conducting propaganda,expert guidance from the related fields,constant improvement the application documents,and formal and content examination.Ultimate goal is to improve the number of grants from National Natural Science Foundation of China.

Improvement in Dropped Head Syndrome (DHS) Following Corticosteroid Injections on the Tender Points at the Upper Thoracic Spine : A Case Report / The Japanese Journal of Rehabilitation Medicine

　An 83-year-old woman presented with dropped head syndrome (DHS), that had been progressing during the previous 6 months. She had no history of neuromuscular diseases and, on examination, no neuromuscular abnormalities were observed except for isolated weakness of the neck extensors, mainly of the semispinalis cervicis. On the paravertebral sites of the T1-T5 spine on both sides, a total of eight points with marked tenderness were noted, four on each side. These eight points coincided with the anatomically narrow spaces through which the posterior rami emerged from their deep exits in the spine (i.e., the intervertebral foramina) to the superficial paravertebral sites, where they bifurcated into the lateral and medial branches, the latter innervating the semispinalis cervicis. Repeated local corticosteroid injections once a week on these eight tender points, with 3.3 mg Decadron (dexamethasone sodium phosphate) mixed with 20 mL of 0.5% xylocaine divided among the eight tender points, improved DHS in 3 months. This case suggests that the anatomically narrow pathway of the medial branches of the posterior rami at the upper thoracic spine could induce inflammations of the passing nerves, resulting in neck extensor weakness.

Rheumatoid arthritis treated with acupoint application of:a rando-mized controlled trial / 中国针灸

<p><b>OBJECTIVE</b>To observe the clinical efficacy differences on rheumatoid arthritis treated with acupoint application of(preparation ofmedicine), tender point herbal application and leflunomide.</p><p><b>METHODS</b>Ninety-six patients were randomized into an acupoint herbal application group, a tender point herbal application group and a leflunomide group, 32 cases in each one. In the acupoint herbal application group,paste was used at Dazhui (GV 14), Mingmen (GV 4), Zusanli (ST 36) and the local points on themeridians around the knee joint. In the tender point herbal application group, the self-preparedmedicine was used at tender points, 4 to 6 h each time, at the interval of 7 days. In the leflunomide group, leflunomide was applied for oral administration, 50 mg on each of the first 3 days, once a day; 20 mg each time 3 days later, once a day. The treatment for 1 month made one session in the three groups, and continuous three sessions of treatment were required. The clinical symptoms, laboratory indices such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF) and the total score of symptoms were observed before and after treatment in the patients of three groups. The efficacy was evaluated in the 3 groups.</p><p><b>RESULTS</b>The total effective rate was 87.5% (28/32) in the acupoint herbal application group and was 90.6% (29/32) in the leflunomide group, better than 68.8% (22/32) in the tender point herbal application group (both<0.05). After treatment, the clinical symptoms, laboratory indices and the total score of symptoms were all improved as compared with those before treatment in the three groups (all<0.05). Among the three groups, the results of pain, swelling, tenderness and the total score of symptoms as well as ESR and RF in the acupoint herbal application group and the leflunomide group were all better than those in the tender point herbal application group (<0.05,<0.01). Blister and pruritus occurred in 2 cases in each of the acupoint herbal application group and the tender point herbal application group. Nausea and poor appetites in 2 cases, dizziness and lassitude in 1 case and skin rashes in 1 case occurred in the leflunomide group.</p><p><b>CONCLUSIONS</b>The improvements in the symptoms of rheumatoid arthritis and laboratory indices in the acupoint herbal application ofare better than those in the treatment with tender point herbal application. The efficacy of it is similar to that of leflunomide, without adverse reactions such as nausea, poor appetite, dizziness and lassitude.</p>

Potentiation of anti-cholelithogenic influence of dietary tender cluster beans (Cyamopsis tetragonoloba) by garlic (Allium sativum) in experimental mice.

Background & objectives: Dietary fibre-rich tender cluster beans (Cyamopsis tetragonoloba; CB) are known to exert beneficial cholesterol lowering influence. We examined the influence of a combination of dietary tender CB and garlic (Allium sativum) in reducing the cholesterol gallstone formation in mice. Methods: Cholesterol gallstones were induced in Swiss mice by feeding a high-cholesterol diet (HCD) for 10 wk. Dietary interventions were made with 10 per cent CB and 1 per cent garlic included individually or together along with HCD. A total of 100 mice were divided into five groups of 20 mice each. Results: Dietary CB, garlic and CB+garlic reduced the formation of cholesterol gallstones by 44, 25 and 56 per cent, respectively, lowered cholesterol by 23-48, 16-24, and 24-58 in bile, serum, and liver, respectively. Cholesterol saturation index in bile and cholesterol: phospholipid ratio in circulation and hepatic tissue were significantly lowered by these dietary interventions, with highest beneficial effect from CB+garlic. Activities of hepatic cholesterol metabolizing enzymes were modulated by CB, garlic and CB+garlic. Elevation in lipid peroxides caused by HCD was also countered by these dietary interventions, the combination producing the highest effect. Interpretation & conclusions: The results showed that the prevention of experimentally induced formation of cholesterol gallstones by dietary CB and garlic was due to decreased biliary cholesterol secretion and increased cholesterol saturation index. In addition of anti-lithogenic effect, dietary CB and garlic in combination had a beneficial antioxidant effect.

Hydatid cyst of bone.

Hydatid disease is an extremely uncommon differential diagnosis in the cystic/lytic lesions of bone. We present a rare case of echinococcal infection of femur which presented as pathological fracture in a middle-aged female and diagnosis was confirmed by histopathology. Hydatid disease of bone is often asymptomatic, and its diagnosis is usually made when lesions have become extensive.

Clinical Observation of Thread Embedding at Tender Points on the Governor Vessel for Intractable Insomnia / 上海针灸杂志

ObjectiveTo observe the efficacy of thread embedding at tender points on the Governor Vessel in treating intractable insomnia.MethodEighty eligible subjects were randomized into two groups. The thread embedding group was intervened by thread embedding at tender points on the Governor Vessel, while the acupuncture was by ordinary acupuncture.ResultThe recovery and markedly effective rate in the thread embedding group (72.5%) was markedly higher than that in the acupuncture group (45.0%). The Pittsburgh Sleep Quality Index (PSQI) scores were significantly lower after intervention in both groups (P<0.05); the PSQI score in the thread embedding group was significantly lower than that in the acupuncture group after intervention (P<0.05). ConclusionThread embedding at tender points on the Governor Vessel can produce a more significant efficacy than ordinary acupuncture in treating intractable insomnia, and it can more effectively improve sleep quality.

Research on the application of Fuzzy synthesis in medical equipment procurement bidding / 中国医学装备

Objective:To discuss and set up indicator system of medical equipment procurement bidding, propose the evaluation methods which based on Fuzzy synthesis and confirm the most appropriate bidder for improving the management level of hospital in medical equipment purchase. Methods: From the bidder's ability to compete and innovation ability and financial standing and development potential and corporate credibility, five aspects to determine the evaluation index. Establish evaluation index system, the application of fuzzy comprehensive method to analyze the bid scheme offered by the tender.Results: According to the maximum subordinate principle, the evaluation value of the bidder is 0.28, the evaluation value of the B tender is 0.32, the value of the bid quotient is 0.23. Comparison of the comprehensive evaluation of the bid evaluation of the tender score of three, B the highest bid quotient, choose B tender bid.Conclusion:Facing different bidders, in the case of each of the advantages and making program quantification, conducting analysis of fuzzy synthetic method can realize the reasonable choice for medical equipment suppliers.

A study of the clinico-histopathological features of erythematous tender nodules predominantly involving the extremities.

Background: Erythematous tender nodules predominantly involving extremities are frequently encountered in dermatology and rheumatology practice. They are diagnosed based on distinct clinical and histopathological features. However, in clinical situations, considerable overlap is observed that poses a diagnostic challenge. We undertook a study on clinico-histological patterns of inflammatory nodules over extremities. Methods: After detailed history and examination, a preliminary clinical diagnosis was made in 43 cases, followed by skin biopsy from representative nodules. Histological diagnosis made was correlated with clinical features. Results: Of 43 cases, a single clinical diagnosis was made in 25 (58.5%) cases while in the remaining cases more than one diagnosis was considered. On correlating with the histopathological diagnosis, concordance was observed in 51% cases while the remaining showed either histological discordance with clinical diagnosis (14% cases) or were kept in the undecided category (35% cases). Conclusion: Considerable clinico-histological overlap was observed in inflammatory nodules over extremities. Histopathology alone was not helpful in differentiating one entity from another at all times since variable histo-pathological patterns were seen.