[Constructs of the Collaboration between Hospital and Community Pharmacists: Findings from Community Pharmacist Perspective Using Multivariate Analysis and Structural Equation Modeling].

Collaborations between hospital and community pharmacists play a key role in ensuring consistent continuation of pharmacotherapy within official medical care plans designed to promote community-based healthcare. A previous study conducted by the authors clarified the constructs of collaboration between the hospital and community pharmacists from the hospital pharmacist's perspective. In this study, a similar questionnaire was used to survey a group of pharmacies with 424 outlets nationwide, and 244 responses were collected. Factor analysis from the community pharmacists' perspective extracted five latent factors comprising 18 variables, and structural equation modeling yielded a model with a high goodness-of-fit. In the latter model, variables representing "Organizational climate" and "Basic policy on collaboration" formed the foundation of the collaboration between hospital and community pharmacists, while variables representing "Understanding of healthcare policy", "Resources for collaboration", and "Community support systems" represented concepts that flexibly compensated for fluctuations in medical policy. These trends were similar to those of the constructs previously indicated by hospital pharmacists. We performed multiple regression analysis and structural equation modeling to confirm the impact of the inclusion of "Need for collaboration" as a dependent variable on the proposed constructs of hospital-community pharmacist collaboration using different analytical methods. Our results indicated that "Organizational climate", "Basic policy on collaboration", and "Community support systems" affected the "Need for collaboration". Our findings indicate that future studies are needed to confirm and clarify the causal relationships demonstrated by the constructs of hospital-community pharmacist collaboration seen within the current study.

Association of circulating soluble lectin-like oxidized low-density lipoprotein receptor-1 with inflammatory markers and urinary albumin excretion in patients with type 2 diabetes.

OBJECTIVES: The main purpose of the study was to study the association between circulating soluble lectin-like oxidized low-density lipoprotein receptor-1 levels and various markers, including inflammatory markers such as high-sensitivity C-reactive protein and fibrinogen, serum lipids, and renal function, in patients with poorly controlled type 2 diabetes. METHODS: The subjects were 70 patients (men 45, women 25) who were hospitalized for treatment of poor glycemic control. Plasma soluble lectin-like oxidized low-density lipoprotein receptor-1 levels were assayed using a sandwich chemiluminescence enzyme immunoassay. RESULTS: Circulating soluble lectin-like oxidized low-density lipoprotein receptor-1 was significantly positively correlated with lectin-like oxidized low-density lipoprotein-1 ligands containing apolipoprotein B, reflecting modified low-density lipoprotein, and with inflammatory markers such as high-sensitivity C-reactive protein and fibrinogen. In addition, there was a significant positive correlation between soluble lectin-like oxidized low-density lipoprotein receptor-1 and urinary albumin excretion. CONCLUSIONS: Soluble lectin-like oxidized low-density lipoprotein receptor-1 may serve as a marker reflecting the degrees of inflammation and albuminuria in patients with poorly controlled type 2 diabetes.

Hb Phnom Penh Showing Falsely High or Reasonable HbA1c Values Depending on the Type of High-performance Liquid Chromatography System.

We herein report a 50-year-old Chinese woman with Hb Phnom Penh (α117Phe-Ile-α118Thr) showing high or reasonable HbA1c values depending on the type of high-performance liquid chromatography (HPLC) system. A high HbA1c value of 7.5% (HPLC assay: G9) and a reasonable HbA1c value of 5.2% (assay unknown) were observed. Therefore, the patient was refereed to our hospital; the oral glucose tolerance test showed normal glucose tolerance. The HbA1c values measured by an enzymatic assay, immunoassay, and affinity assay, as well as most HPLC assays were within the reference range, whereas those measured by the Tosoh HPLC systems were high.

A novel risk analysis of clinical reference dosimetry based on failure modes and effects analysis.

PURPOSE: The output of a linear accelerator (linac) is one of the most important quality assurance (QA) factors in radiotherapy. However, there is no quantitative rationale for frequency and tolerance. The purpose of this study is to develop a novel risk analysis of clinical reference dosimetry based on failure modes and effects analysis (FMEA). METHODS: Clinical reference dosimetry data and the daily output data of two linacs (Clinac iX and Clinac 6EX) at Hiroshima University Hospital were analyzed. The analysis involved the number of patients per year for five types of fractionations. Risk priority number (RPN) is defined as the product of occurrence (O), severity (S), and detectability (D) in standard FMEA. In addition, we introduced "severity due to output drifting" (mean output change per day) (S') and the number of patients per year for five types of fractionations (W). We calculated the RPN = O × S × D × S' × W and quantitatively evaluated the risk for clinical reference dosimetry. RESULTS: Fewer fractions and less output calibration frequency resulted in higher RPN. Since clinical reference dosimetry data has a drift effect, which is missing in human processes, it was essential to use S' in addition to standard FMEA. Moreover, the parameter W was important in evaluating interinstitutional QA for clinical reference dosimetry. The relative risk of Clinac 6EX to Clinac iX was different approximately by twofold. CONCLUSIONS: We developed a novel index that can quantitatively evaluate risk for clinical reference dosimetry of each facility and machines in common on the basis of FMEA.

Association between angiopoietin-like protein 2 and lectin-like oxidized low-density lipoprotein receptor 1 ligand containing apolipoprotein B in patients with type 2 diabetes.

Objective This study was performed to evaluate the association of the serum level of angiopoietin-like protein 2 (ANGPTL2) with circulating inflammatory markers and oxidized and modified low-density lipoprotein (LDL) cholesterol as evaluated by lectin-like oxidized LDL receptor 1 ligand containing apolipoprotein B (LAB) in patients with type 2 diabetes. Methods The study included 70 patients with type 2 diabetes hospitalized for glycemic control and 9 control subjects. Results The serum level of ANGPTL2 was significantly higher in the patients with type 2 diabetes than in the healthy controls. There was a significant positive correlation between ANGPTL2 and the high-sensitivity C-reactive protein, fibrinogen, and LAB levels and a significant negative correlation between ANGPTL2 and the estimated glomerular filtration rate (eGFR). Conclusions These results suggest that the serum ANGPTL2 level has a close positive association with inflammatory markers, especially fibrinogen and oxidized and modified LDL as evaluated by LAB. The data also suggest that the serum ANGPTL2 level is influenced by renal function as reflected by the eGFR.

A novel verification method using a plastic scintillator imagining system for assessment of gantry sag in radiotherapy.

PURPOSE: High accuracy of the beam-irradiated position is required for high-precision radiation therapy such as stereotactic body radiation therapy (SBRT), volumetric modulated arc therapy (VMAT), and intensity modulated radiation therapy (IMRT). Users generally perform the verification of the mechanical and radiation isocenters using the star shot test and the Winston Lutz test that allow evaluation of the displacement at the isocenter. However, these methods are unable to evaluate directly and quantitatively the sagging angle that is caused by the weight of the gantry itself along the gantry rotation axis. In addition, the verification of the central axis of the irradiated beam that is not dependent at the isocenter is needed for the mechanical quality assurance of a nonisocentric irradiation technique. In this study, we have developed a prototype system for the verification of three-dimensional (3D) beam alignment and we have verified the system concept for 3D isocentricity. Our system allows detection of the central axis in 3D coordinates and evaluation of the irradiated oblique angle to the gantry rotation axis, i.e., the sagging angle. MATERIALS & METHODS: In order to measure the central axis of the irradiated beam in 3D coordinates, we constructed the prototype verification system consisting of a column-shaped plastic scintillator (CoPS), a truncated cone-shaped mirror (TCsM), and a cooled charged-coupled device (CCD) camera. This verification system was irradiated with 6-MV photon beams and the scintillation light was measured using the CCD camera. The central axis on the axial plane (two-dimensional (2D) central axis) was acquired from the integration of the scintillation light along the major axis of the CoPS, and the central axis in 3D coordinates (3D central axis) was acquired from two curve-shaped profiles which were reflected by the TCsM. We verified the calculation accuracy of the gantry rotation axis, θz . Additionally, we calculated the 3D central axis and the sagging angle at each gantry angle. RESULTS: We acquired the measurement images composed of the 2D central axis and the two curve-shaped profiles. The relationship between the irradiated and measured angles with respect to the gantry rotation axis had good linearity. The mean and standard deviation of the difference between the irradiated and measured angles were 0.012 and 0.078 degrees, respectively. The size of the 2D and 3D radiation isocenters were 0.470 and 0.652 mm on the axial plane and in 3D coordinates, respectively. The sagging angles were -0.31, 0.39, and 0.38 degrees at the gantry angles of 0, 180, and 180E degrees, respectively. CONCLUSION: We developed a novel verification system, designated as the "kompeito shot test system," to verify the 3D beam alignment. This system concept works for both verification of the 3D isocentricity and the direct evaluation of the sagging angle. Next, we want to improve the aspects of this system, such as the shape and the type of scintillator, to increase the system accuracy and nonisocentric beam alignment performance.

Relative biological effectiveness study of Lipiodol based on microdosimetric-kinetic model.

OBJECTIVES: We examine the contrast agent Lipiodol effect on the relative biological effectiveness (RBE) values for flattening filter free (FFF) and flattening filter (FF) beams of 6 MV-Xray (6 MVX) and 10 MVX. METHODS: Lipiodol was placed at 5 cm depth in water. According to the microdosimetric kinetic model, the RBE values for killing the human liver hepatocellular cells were calculated from dose and lineal energy (yd(y)) from Monte Carlo simulations. RBE200kVX and RBECo were defined as the ratios of dose using reference radiation (200 kVX, Co-ɤ) to the dose of test radiation (FFF and FF beams for 6 MV and 10 MV) to produce the same biological effects. The dose enhancement RBE (RBEDE) was defined as the ratios of a dose without Lipiodol to with Lipiodol using to produce the same biological effects. The dose needed to achieve 10% (D10%) and 1% cell survival (D1%) was evaluated by cell surviving fraction (SF) formula. RESULTS: The deviation of mean y‾D values with and without Lipiodol were 3.9-4.8% for 6 MVX and 3.5-3.6% for 10 MVX. The RBE200kVX and RBECo with Lipiodol were larger than that without Lipiodol. The RBEDE was larger for FFF beam than for FF beam. The deviation of RBEDE for FFF and FF beams of 6 MVX was larger than that of 10 MVX. CONCLUSION: The presence of Lipiodol seemed to locally increase the absorbed dose and to also cause an enhancement of the relative biological effectiveness.

Isolated Adrenocorticotropic Hormone Deficiency and Severe Hypercalcemia After Destructive Thyroiditis in a Patient on Nivolumab Therapy With a Malignant Melanoma.

We describe a 58-year-old man with a malignant melanoma metastasis to the liver. After initiation of nivolumab therapy, he developed destructive thyroiditis and subsequently simultaneous isolated adrenocorticotropic hormone (ACTH) deficiency and severe hypercalcemia. Although isolated ACTH deficiency and hypercalcemia due to nivolumab therapy are both rare occurrences, these conditions can often cause a severe clinical course accompanied by a disturbance of consciousness. Therefore, clinicians should pay attention to these possible side effects of nivolumab if the patients have clinical symptoms, such as fatigue and a disturbance of consciousness.

Estimation of patient-specific imaging dose for real-time tumour monitoring in lung patients during respiratory-gated radiotherapy.

PURPOSE: To quantify the patient-specific imaging dose for real-time tumour monitoring in the lung during respiratory-gated stereotactic body radiotherapy (SBRT) in clinical cases using SyncTraX. METHODS AND MATERIALS: Ten patients who underwent respiratory-gated SBRT with SyncTraX were enrolled in this study. The imaging procedure for real-time tumour monitoring using SyncTraX was simulated using Monte Carlo. We evaluated the dosimetric effect of a real-time tumour monitoring in a critical organ at risk (OAR) and the planning target volume (PTV) over the course of treatment. The relationship between skin dose and gating efficiency was also investigated. RESULTS: For all patients, the mean D50 to the PTV, ipsilateral lung, liver, heart, spinal cord and skin was 118.3 (21.5-175.9), 31.9 (9.5-75.4), 15.4 (1.1-31.6), 10.1 (1.3-18.1), 25.0 (1.6-101.8), and 3.6 (0.9-7.1) mGy, respectively. The mean D2 was 352.0 (26.5-935.8), 146.4 (27.3-226.7), 90.7 (3.6-255.0), 42.2 (4.8-82.7), 88.0 (15.4-248.5), and 273.5 (98.3-611.6) mGy, respectively. The D2 of the skin dose was found to increase as the gating efficiency decreased. CONCLUSIONS: The additional dose to the PTV was at most 1.9% of the prescribed dose over the course of treatment for real-time tumour monitoring. For OARs, we could confirm the high dose region, which may not be susceptible to radiation toxicity. However, to reduce the skin dose from SyncTraX, it is necessary to increase the gating efficiency.

Effect of secondary electron generation on dose enhancement in Lipiodol with and without a flattening filter.

PURPOSE: Lipiodol, which was used in transcatheter arterial chemoembolization before liver stereotactic body radiation therapy (SBRT), remains in SBRT. Previous we reported the dose enhancement in Lipiodol using 10 MV (10×) FFF beam. In this study, we compared the dose enhancement in Lipiodol and evaluated the probability of electron generation (PEG) for the dose enhancement using flattening filter (FF) and flattening filter free (FFF) beams. METHODS: FF and FFF for 6 MV (6×) and 10× beams were delivered by TrueBeam. The dose enhancement factor (DEF), energy spectrum, and PEG was calculated using Monte Carlo (MC) code BEAMnrc and heavy ion transport code system (PHITS). RESULTS: DEFs for FF and FFF 6× beams were 7.0% and 17.0% at the center of Lipiodol (depth, 6.5 cm). DEFs for FF and FFF 10× beams were 8.2% and 10.5% at the center of Lipiodol. Spectral analysis revealed that the FFF beams contained more low-energy (0-0.3 MeV) electrons than the FF beams, and the FF beams contained more high-energy (>0.3 MeV) electrons than the FFF beams in Lipiodol. The difference between FFF and FF beam DEFs was larger for 6× than for 10×. This occurred because the 10× beams contained more high-energy electrons. The PEGs for photoelectric absorption and Compton scattering for the FFF beams were higher than those for the FF beams. The PEG for the photoelectric absorption was higher than that for Compton scattering. CONCLUSIONS: FFF beam contained more low-energy photons and it contributed to the dose enhancement. Energy spectra and PEGs are useful for analyzing the mechanisms of dose enhancement.

Energy spectrum and dose enhancement due to the depth of the Lipiodol position using flattened and unflattened beams.

AIM: Lipiodol was used for stereotactic body radiotherapy combining trans arterial chemoembolization. Lipiodol used for tumour seeking in trans arterial chemoembolization remains in stereotactic body radiation therapy. In our previous study, we reported the dose enhancement effect in Lipiodol with 10× flattening-filter-free (FFF). The objective of our study was to evaluate the dose enhancement and energy spectrum of photons and electrons due to the Lipiodol depth with flattened (FF) and FFF beams. METHODS: FF and FFF for 6 MV beams from TrueBeam were used in this study. The Lipiodol (3 × 3 × 3 cm3) was located at depths of 1, 3, 5, 10, 20, and 30 cm in water. The dose enhancement factor (DEF) and the energy fluence were obtained by Monte Carlo calculations of the particle and heavy ion transport code system (PHITS). RESULTS: The DEFs at the centre of Lipiodol with the FF beam were 6.8, 7.3, 7.6, 7.2, 6.1, and 5.7% and those with the FFF beam were 20.6, 22.0, 21.9, 20.0, 12.3, and 12.1% at depths of 1, 3, 5, 10, 20, and 30 cm, respectively, where Lipiodol was located in water. Moreover, spectrum results showed that more low-energy photons and electrons were present at shallow depth where Lipiodol was located in water. The variation in the low-energy spectrum due to the depth of the Lipiodol position was more explicit with the FFF beam than that with the FF beam. CONCLUSIONS: The current study revealed variations in the DEF and energy spectrum due to the depth of the Lipiodol position with the FF and FFF beams. Although the FF beam could reduce the effect of energy dependence due to the depth of the Lipiodol position, the dose enhancement was overall small. To cause a large dose enhancement, the FFF beam with the distance of the patient surface to Lipiodol within 10 cm should be used.

Accuracy of the raw-data-based effective atomic numbers and monochromatic CT numbers for contrast medium with a dual-energy CT technique.

OBJECTIVE: To evaluate the accuracy of raw-data-based effective atomic number (Zeff) values and monochromatic CT numbers for contrast material of varying iodine concentrations, obtained using dual-energy CT. METHODS: We used a tissue characterization phantom and varying concentrations of iodinated contrast medium. A comparison between the theoretical values of Zeff and that provided by the manufacturer was performed. The measured and theoretical monochromatic CT numbers at 40-130 keV were compared. RESULTS: The average difference between the Zeff values of lung (inhale) inserts in the tissue characterization phantom was 81.3% and the average Zeff difference was within 8.4%. The average difference between the Zeff values of the varying concentrations of iodinated contrast medium was within 11.2%. For the varying concentrations of iodinated contrast medium, the differences between the measured and theoretical monochromatic CT values increased with decreasing monochromatic energy. The Zeff and monochromatic CT numbers in the tissue characterization phantom were reasonably accurate. CONCLUSION: The accuracy of the raw-data-based Zeff values was higher than that of image-based Zeff values in the tissue-equivalent phantom. The accuracy of Zeff values in the contrast medium was in good agreement within the maximum SD found in the iodine concentration range of clinical dynamic CT imaging. Moreover, the optimum monochromatic energy for human tissue and iodinated contrast medium was found to be 70 keV. Advances in knowledge: The accuracy of the Zeff values and monochromatic CT numbers of the contrast medium created by raw-data-based, dual-energy CT could be sufficient in clinical conditions.

Long-Term Effect of Alogliptin on Glycemic Control in Japanese Patients With Type 2 Diabetes: A 3.5-Year Observational Study.

BACKGROUND: The goal of the current study was to investigate the long-term effects (after 3 years or more) of alogliptin on glycemic control in Japanese patients with type 2 diabetes. METHODS: We retrospectively studied the effect of alogliptin on glycemic control in the patients with type 2 diabetes who had participated in our previous 3-month study and who continued to take alogliptin for at least 36 months. RESULTS: The mean duration of alogliptin treatment was 42.8 ± 2.2 months. In all 39 patients, a significant reduction in hemoglobin A1c (HbA1c) levels was noted between the baseline and final visit: 7.8±0.6% to 7.2±1.0% (P = 0.0001). A significant reduction in HbA1c levels was found in a subgroup of patients who did not change their anti-diabetic drugs or did decrease the dose of their sulfonylureas (SUs) or did change to a lower strength repaglinide (n = 32): 7.7±0.6% to 7.2±1.0% (P = 0.0005). A significant decrease in low-density lipoprotein cholesterol (LDL-C) levels was observed in all of the patients that had LDL-C levels determined (P = 0.0406) (n = 37), and in a subgroup of patients who had not taken either statins, fibrates, or pioglitazone, or who had taken one or more of these drugs but the doses were not changed during the observation period (P = 0.0250) (n = 27). CONCLUSION: The current study found that alogliptin performed well for glycemic control when evaluated by HbA1c levels in a long-term observation period exceeding 3 years in Japanese patients with type 2 diabetes. Alogliptin may also decrease circulating LDL-C levels with long-term use.

Dosimetric impact of Lipiodol in stereotactic body radiation therapy on liver after trans-arterial chemoembolization.

PURPOSE: Stereotactic body radiation therapy (SBRT) combining trans-arterial chemoembolization (TACE) with Lipiodol is expected to improve local control. This study is aimed to estimate the dose enhancement in Lipiodol's proximity and to evaluate the dose calculation accuracy of the Acuros XB (AXB) algorithm and anisotropic analytical algorithm (AAA) in the Eclipse treatment planning system (TPS) (ver. 11, Varian Medical Systems, Palo Alto, USA), compared with that of the Monte Carlo (MC) calculation (using BEAMnrc/DOSXYZnrc code) for a virtual phantom and a treatment plan for liver SBRT after TACE. METHODS: The MC calculation accuracy was validated by comparing its results with the percent depth dose (PDD) and the off-axis ratio (OAR) measured using a water-equivalent phantom containing Lipiodol. The dose difference in Lipiodol's proximity and the inhomogeneity correction accuracies of the AAA, AXB algorithm, and MC calculation were evaluated by calculating the PDDs and OARs for the virtual phantom with Lipiodol and the lateral profile for the clinical plan data. RESULTS: The measured data and the MC results agreed within 3%. The average dose in the Lipiodol uptake region was higher by 8.1% for the virtual phantom and 6.0% for the clinical case compared to that in regions without Lipiodol uptake. For the virtual phantom, compared with the MC calculation, the AAA and the AXB algorithm underestimated the doses immediately upstream of the Lipiodol region by 5.0% and 4.2%, in the Lipiodol region by 7.4% and 9.8%, and downstream of the Lipiodol region by 5.5% and 3.9% respectively. These discrepancy between the AXB and MC calculations were due to the incorrect assignment of Lipiodol material properties. Namely, the bone material was assigned automatically by the AXB algorithm as the materials for the AXB algorithm do not contain iodine, which is the main constituent of Lipiodol. CONCLUSIONS: The MC calculation indicated a larger and more accurate dose increase in Lipiodol compared with the TPS algorithms. The observed dose enhancement in the tumor area could be clinically significant.

Absorbed dose and image quality of Varian TrueBeam CBCT compared with OBI CBCT.

PURPOSE: Nowadays, patient positioning and target localization can be verified by using kilovolt cone beam computed tomography (kV-CBCT). There have been various studies on the absorbed doses and image qualities of different kV-CBCT systems. However, the Varian TrueBeam CBCT (TB CBCT) system has not been investigated so far. We assess the image quality and absorbed dose of TB CBCT through comparison with those of on-board imager (OBI) CBCT. METHODS: The image quality was evaluated using two phantoms. A CATPHAN phantom measured the image quality parameters of the American Association of Physicists in Medicine Task Group 142 (AAPM TG-142) report. These factors are the pixel value stability and accuracy, noise, high-contrast resolution, low-contrast resolution, and image uniformity. A H2SO4 phantom was used to evaluate the image uniformity over a larger region than the CATPHAN phantom. In evaluating the absorbed dose, the radial dose profile and the patient organ doses at the prostate and rectum levels were evaluated. RESULTS: The image quality parameters of AAPM TG-142 using TB CBCT are equal to or greater than those of OBI CBCT. In particular, the contrast-to-noise ratio with TB CBCT is 2.5 times higher than that with OBI CBCT. For the test of a large field uniformity, the maximum difference in the Hounsfield unit (HU) values between the centre and peripheral regions is within 30 HU with TB CBCT and 283 HU with OBI CBCT. The maximum absorbed dose with TB CBCT is decreased by 60%. CONCLUSIONS: We find that the image quality improved and the absorbed dose decreased with TB CBCT in comparison to those with OBI CBCT. Its image uniformity is also superior over a larger scanning range.

Effect of combination therapy with alogliptin and lansoprazole on glycemic control in patients with type 2 diabetes.

The main purpose of the current study was to investigate the effect of a combination of alogliptin [a dipeptydil peptidase (DPP)-4 inhibitor] and lansoprazole [a proton pump inhibitor (PPI)] compared with alogliptin mono-therapy on glycemic control in patients with type 2 diabetes. This study was a multicenter randomized open-label study. One hundred type 2 diabetic patients were randomly assigned to either the alogliptin with lansoprazole group or the alogliptin mono-therapy group. After 3 months of treatment, the changes in hemoglobin (Hb)A1c, fasting plasma glucose (FPG), serum gastrin, homeostasis model assessment (HOMA)-ß, and HOMA-insulin resistance (IR) were evaluated. A significant decrease in HbA1c and FPG, and a significant increase in HOMA-ß were observed in both groups (all with P <0.0001). However, there were no significant differences in changes in HbA1c, FPG, or HOMA-ß before and after therapy between the combination and alogliptin mono-therapy group (P =0.2945, P =0.1901, P =0.3042, respectively). There was a significant elevation of serum gastrin in the combination group compared with the alogliptin mono-therapy group (P =0.0004). This study showed that, although combination therapy with alogliptin and lansoprazole more effectively elevated serum gastrin levels compared with alogliptin mono-therapy, the effect of the combination therapy on glycemic control was equal to that of alogliptin mono-therapy during a 3-month study period.

[Primary meaning and pathology of the "Jue": significance of the clinical case of the Guo prince treated by Bianque].

The "Jue" refers to a disease appearing frequently in the ancient book of Traditional Chinese Medicine. The definition of "Jue" is ambiguous because of various cognitions of this illness today. We studied the primary meaning of "Jue" in Suwen, Lingshe and the chapter of Bianqueyun in Shiji and revealed the following results. In general, it is believed that the "Jue" will be caused by an imbalance between internal "Yin" and "Yang." The "Qi" of the external world, which varies according to each season or day and night, additionally seems to influence the inner body. In the pathology of "Jue", when the external "Qi" cannot reach the deep part of the body, at first, the internal "Qi" deviates from the natural course and cannot work in the body. The spirit in the deep part, subsequently, cannot work freely and paroxysmally changes location to the upper and surface parts of the body. The Guo prince's disease noted in the chapter of Bianqueyun in Shiij seems to have been a case of "Jue". In the case of the Guo prince, the method of treatment with "Sanyangwushu" by Bianque was based on the theory of "Sanbujiuhouzhen" which is a classic diagnosis in Suwen.

[Reexaminations of dosages in Shanghanlun: comparison of the dosages among decoctions, pills and powder formulations].

This paper reveals the dosages of decoctions in Shanghanlun in relation of pills and powder formulations, and obtains following results. At the first examination of the system of weight, while Taohongjing shows three kinds of system of weight; [(1)1liang is equivalent to 14 g. (2) 1liang = 7 g (3) 1liang = 1.4 g], he describes the necessity of the corrective system of weight among the decoctions, the pills and the powder formulations. After Song dynasty, Zhusanfa, which is the method of preparing the decoction by placing powder ingredients of prescriptions in water and simmer, have been mainly adopted. In the term of Zhusanfa, although the whole quantities of prescriptions are written with the ancient weight unit, the notation of the dosage is indicated by the current weight unit, Qian. In Shanghanlun, since the dosage form seems to have been changed from the pills or the powders into the decoction, some of decoctions contain impractical dose for decoction.

[Significance of Sijiseiki disease and Henseibyo disease on the Shanghanli chapter in the Shanghanlun].

It seemed that the chapter "Shanghanli" in Shanghaulun had been incorporated into the text of the Shanghanlun by "Wang shuhe". Therefore, the "Shanghanli" wasn't studied as adequately as the original Shanghanlun written by "Zhang Zhongjing. We focused on the significance of "Sijiseiki" disease and "Henseibyo" disease in the chapter "Shanghanli" and revealed their relation to the ideas on pathology in the Shanghanlun. In the theory of "Sijiki", the four seasons each had their own "Qi", called "Sijiki"; the cold belonging to winter, the warm to spring, the hot to summer and the cool to autumn. The influence of "Sijiki" in each season caused the disease of "Sijiseiki". Since "Sijiki" was related to the normal "Qi" for each season, "Sijiseiki" disease was expected to be recovered from in order. When "Sijiseiki" disease had not been cured in each season, it caused a complex disease according to the influence of other seasonal "Sijiki"; "Henseibyo" disease.

The validity of mass body temperature screening with ear thermometers in a warm thermal environment.

Identification of people who have a fever in public places during the occurrence of emerging infectious diseases is essential for controlling disease spread. The measurement of body temperature could identify infected persons. The environment affects body temperature, but little is known about the validity of measurements under different thermal environments. Therefore, the aim of this study was to determine the validity of measuring body temperature in cold and warm environments. We recruited 50 participants aged 18-69 years (26 males, 24 females) to measure body temperature using an axillary thermometer and an ear thermometer and by infrared thermal imaging (thermography). The body temperature obtained with an axillary thermometer was used as a reference; receiver operating characteristic (ROC) analysis was conducted to determine the validity of temperatures obtained by measurement with an ear thermometer and thermography at 36.7°C (median of the axillary body temperature). The area under the ROC curve (AUC) indicates the validity of measurements. The AUC for ear thermometers in a warm environment (mean temperature: 20.0°C) showed a fair accuracy (AUC: 0.74 [95% CI: 0.64-0.83]), while that (AUC: 0.62 [95% CI: 0.51-0.72]) in a cold environment (mean temperature: 12.6°C) and measurements with thermography used in both environments (AUC: 0.57 [95% CI: 0.45-0.68] in a warm environment and AUC: 0.65 [95% CI: 0.54-0.76] in a cold environment) showed a low accuracy. In conclusion, in a warm environment, measurement of body temperature with an ear thermometer is a valid procedure and effective for mass body temperature screening.