Akino Wakasugi

The efficacy of goshuyuto, a typical Kampo (Japanese herbal medicine) formula, in preventing episodes of headache.

ABSTRACT Objective: The purpose of this clinical trial was to assess the efficacy of goshuyuto, a typical Kampo formula, in preventing episodes of headache in chronic headache patients. Research design and methods: Because the treatment target of a Kampo formula is decided on a basis different to that of Western medicine, we first selected patients belonging to a subgroup that responded to goshuyuto before conducting the usual randomized controlled trial. During stage 1, the subjects were instructed to orally consume goshuyuto for 4 weeks. Only those subjects judged as responders advanced to stage 2, during which a double-blind, randomized, placebo-controlled study was conducted. The subjects consumed the same dose of goshuyuto or placebo for 12 weeks. Results: Of the 91 subjects enrolled in stage 1, 60 were judged as responders. Of these, 53 advanced to stage 2; 28 were assigned to the goshuyuto group and 25 to the placebo group. The decrease in the number of days on which headache episodes occurred was greater in the goshuyuto group than in the placebo group (2.6 ± 3.7 vs. 0.3 ± 4.0 days, p = 0.034); no difference was observed with regard to the reduction in the frequency of consuming reliever medications (2.2 ± 4.0 vs. 1.4 ± 8.2, p = 0.672). Improvement in the associated symptoms was observed in more than 50% of the subjects in the goshuyuto group. Conclusion: Goshuyuto is useful in preventing episodes of headache in chronic headache patients. Responder-limited design is a candidate for evaluating Kampo medicine.

Effects of goshuyuto on lateralization of pupillary dynamics in headache.

Autonomic nervous imbalance is implicated in chronic headache. We investigated the effects of goshuyuto-a representative Kampo medicine for headache-on the lateralization of the pupillary autonomic nervous system by using binocular infrared video pupillography. Patients with chronic headache were administered goshuyuto extract for 1 month (1st stage). Goshuyuto was discontinued for 1 month, following which the patients were randomly divided into 2 groups: placebo and goshuyuto. In the 2nd stage, the respective groups were administered placebo or goshuyuto for 3 months. The average laterality of the pupillary dynamics decreased significantly in the goshuyuto group. These results suggest that the reduction of the difference in pupillary autonomic balance between the left and right eyes might be one of the action mechanisms of goshuyuto to relieve chronic headache.

Repair and Reconstruction of the Mouse Lens after Perforating Injury

PURPOSE To investigate the process of repair in the epithelial cells and the reconstruction in lens fibers of a mouse lens that has developed opacity because of a large-scale perforating injury. METHODS Lenses of 4-week-old mice were perforated with a needle through the cornea to induce the development of traumatic cataracts. Over the period from the first day to the fifth month after injury, eyeballs were extracted progressively from the mice and changes in the epithelial cells of these lenses were observed morphologically as well as histochemically. RESULTS Following the injury, the epithelial cells of the lenses extended toward the center of the injury, while undergoing repeated proliferation and stratification. After a month, the epithelial cells completely covered the entire injury. Later, a basal lamina and collagen fibers developed among the epithelial cells that had proliferated, the intracellular space enlarged, but the number of cells decreased. Histochemically, a strong actin-positive finding was observed in the epithelial cells in the growth phase. On the other hand, an investigation by means of the TUNEL method revealed epithelial cell death and a decrease in cell number. Maximal cell death was observed in the second month. During this period, lens fibers regenerated, and the clear areas of the cortex increased. CONCLUSION Although the lenses exhibited opacity over a large area, the epithelial cells eventually fully covered the injured area. Once the repair was completed, the number of epithelial cells decreased. At the same time, the lenses were found to have developed increased clarity, leading to reconstruction. The epithelial recovery and the residual posterior suture may be the key to the reconstruction of the lenses.

Response of the Mouse Lens to Varying Sizes of Injured Area

PURPOSE To examine the response of the lens to varying sizes of perforating injury. METHODS Four-week-old mice were used. Injuries consisted of pricking in the central region of the lens by transcorneal insertion of needles of two different sizes. After injury, the eyeballs were removed sequentially at various intervals up to 30 days and examined morphologically. RESULTS The mouse lens showed three patterns of reaction; retained transparency, posterior opacity, and anterior opacity. (1) When the lens remained clear, the injury was small in area. The damaged portion of the lens was repaired by epithelial proliferation. (2) When opacity occurred abruptly at the posterior cortical area, epithelial damage was mild and lens fiber damage was relatively severe. Evans blue dye moved toward the posterior polar region along the cortical fiber arrangement. (3) When opacity developed abruptly at the anterior cortex, the size of epithelial damage and the damage to lens fibers were extensive. The posterior cortex remained transparent. Evans blue dye remained in the anterior polar region just beneath the injured part. CONCLUSION It was found that the size of the injured area is a determinant of repair or opacity, and the site of opacity is dependent on the severity of epithelial damage and the location of the liquefied area.

The Effect of Continuous Low Doses of X-ray Irradiation on the Rat Lens

PURPOSE To clarify the morphological changes in the rat lens after irradiation with continuous low doses of x-ray at different intervals. METHODS Male Wistar rats at the age of 8 weeks were irradiated with three doses of 2 Gy at intervals of either 1 week or 1 day. Over the period from the first week to the eighth week after irradiation, the eyeballs of the rats were enucleated progressively and changes in the lenses were examined morphologically. A comparison was made with specimens from control rats at each time of enucleation. RESULTS (1) Three doses of weekly irradiation: 1 week later, the lens epithelium and fibers at the equator showed mild swelling. Bow configuration was slightly disturbed. Eight weeks later, swelling and uneven height of epithelial cells in the equatorial area, irregular bow configuration, swelling of cortical fibers and epithelial loss and deformed nuclei at the central epithelium were observed. (2) Three doses of daily irradiation: 1 week later, mild changes in the lens such as uneven height of epithelial cells, irregular bow structures, and swelling of cortical fibers were observed. Eight weeks later, irregular bow configuration, posterior dislocation of nuclei, severe epithelial loss and marked swelling of cortical fibers were observed at the equatorial area. Epithelial loss and deformed nuclei of the epithelium were observed in the central area. CONCLUSION The lens was damaged by continuous irradiation even though the dose was low. The damage to the lens caused by daily irradiation was more severe than that by weekly irradiation. The main symptoms were degeneration and loss of epithelial cells and swelling of cortical fibers.

Prescription Prediction towards Computer-Assisted Diagnosis for Kampo Medicine

This paper focuses on the attempt to formulate the prescription prediction logic based on the medical data analysis towards the future computer-assisted-diagnosis for Kampo medicine. We constructed and evaluated prediction models for some frequently-used prescriptions using six kinds of machine learning algorithms including artificial neural network, multinomial logit, random forest, support vector machine, k-nearest neighbor, and decision tree. The possibility of prescription prediction and the necessary amount of data required for robust prediction are clarified.