In the previous paper, we reported on the pathways of PSC and also upon the coincedent rates of PSC and the classical meridians.
In this paper, some remarkable observations on the PSC of the same patient are reported on: the echo sensation of PSC on the posterior median extra meridian, the inn-ue extra meridian and the regular meridians, excepting the heart meridian, reached to the head where the patient had her chief complaint. The farthest traveled echo sensation of PSC was on the inn-ue extra meridian and the broadest on the kidney meridian, the bladder meridian and the yan-wei extra meridian. PSC displayed body symetry and reproducibility. Fingerpressure applied at a point along the path of echo sensation served to interrupt the sensation over an area immediately following that point. The spatial length of PSC was enlarged by heating the area in question.

We treated a patient (aged 57, a housewife, traumatic cervical syndrome), to be called a meridian sensitive patient, who displayed definite meridian phenomenon.
In the patient, a type of meridian phenomena, Phenomenon of Propagated Sensation along the Channels (PSC), was examined. Reffering the Nagahama and Maruyama's method and the method used in China, we employed a method whereby a pressure stimulus was applied with a press needle alternately to the terminal point on each of the 12 regular meridians as well as to a certain point on each of the extra meridians.
As a result, the following coincidence rates of PSC and the classical meridians were obtained:
20% (the small intestine meridian, the posterior median extra meridian, the impetuous pulse and the extra meridian around the waist) of all the 20 meridians were almost entirely coincident.
55% of all the meridians were partly coincident.
25% (the spleen pancreas meridian, the heart meridian, the pericardium meridian, the lung meridian and the anterior midline meridian) were not coincident.

In order to investigate the meridian phenomenon elicited by the stimulation on auricular acupuncture point, a patient, 58-year old, in whom marked meridian phenomena are observed on the body was selected as a subject.
The stimuli were ginen by means of a low frequency electrical stick method on the 210 auricular-points of the left ear.
The echo sensation to the remote district from the auriculo-points stimulated was observed in about 30% of the total points.
In 4.3%, the site to which echo sensation reached corresponded to the response organ that is expresed in the name of point. A point named “anesthetic point for tooth extraction” was one of the representatives.
The comfortable feeling over head, eyes, and whole body was also observed when stimulation was given to these points.

We have carried out a health developing project for three years at two flat rural areas in Ibaraki prefecture, O in Ushiku town and N in Iwai city, taking female farmers as the subjects.
As a result, people in these areas obtained by developing reciprocal assistance a belief in selfsupport and knowledge of diseases, which lead to remarkable progress of their health such as improvement of nutrition and cosolidation of agricultural and life environment. Some observations in the study are discussed below.
1) In the two areas, the number of people with no abnormality increased while those requiring care decreased, The number of people to be treated or under treatment was nearly unchanged, probably because of chronic deseases. No death and complication occured during the three years.
2) Owing to the difference between O and N areas in the age structure of examinees, areal characteristics and types of agricultural products, the results of health examinations in these two areas were somewhat different.
3) The health developing project will become more effective if male farmers participate together with the female farmers.
4) Continuation of the health care activity in these areas will establish voluntary organizations of residents.

　　Although axillary lymph node dissection (ALND) is conventionally indicated for metastasis in the sentinel lymph node (SLN), the omission of ALND is being discussed more often in recent years. However, because of the lack of specific guidelines, it is unclear which cases should be treated without ALND. In this study, we performed one-step nucleic acid amplification of the SLN with metastasis to determine the total tumor load (TTL), that is, the number of cytokeratin (CK) 19 mRNA copies. After ultrasonography (US) of ALN, the ultrasonographic findings were combined with TTL to rate SLN metastasis. In the rating, a total score was obtained by assigning 1 point each for (a) TTL of ≥15000 copies/μL, (b) US findings of a long-to-short LN diameter ratio of ≤2, and (c) US findings of no echogenic hilus. We then investigated the association between the total score and metastasis in the non-SLN. Results showed that while 87.5% (5/6) of patients with positive non-SLN scored ≥2 points, only 3.1% (1/34) of patients with negative non-SLN did so, suggesting that a total copy number of CK19 mRNA, US findings of a long-to-short LN diameter ratio, and the presence/absence of echogenic hilus are important predictors for non-SLN metastasis. This novel scoring system is expected to help determine which patients need ALND or what postoperative therapy is necessary.

The purpose of this study was to confirm the causal structure model of muscle, motor and living functions utilizing structural equation modeling (SEM) . As subjects, 103 community-dwelling older men and women, aged 65.7±6.9years of age, participated in the study to measure muscle cross-sectional area, maximum voluntary contractions, muscle power, 4 physical performance tests, and 16 questionnaires regarding ability of activities of daily living. The causal structure model of muscle, motor and living functions was hypothesized to be a hierarchical causal structure. The causal structure model of muscle function was hypothesized to be a hierarchical causal structure consisting of 3 sub-domains of muscle mass, muscle strength, and muscle power. Data analysis procedures were as follows : a) testing of construct validity of muscle function variables using confirmatory factor analysis (CFA) in SEM ; b) testing of causal structure using SEM ; c) testing of factor invariance using multi-group analysis for gender. The highest goodness of fit indices was obtained in the causal structure model of muscle, motor and living functions (NFI= .928, CFI= .978, RMSEA =.061) . The causal coefficient of muscle function to motor function was .98 (p<.05), followed by.34 for motor function to living function. From the results of multi-group analysis, the measurement invariance model indicated the highest goodness of fit indices (TLI=.968, CFI .977) . It was concluded that the hierarchical causal relation was among muscle, motor and living functions, and in which muscle function was consisted of 3 sub-domains.

A 78-year-old woman who had a history of left deep venous thrombosis was referred to our hospital with a sudden hemoptysis. Thoracic computed tomography showed a solitary pulmonary nodule in the right lower lobe. Based on her medical history of deep venous thrombosis, she was tentatively diagnosed as having pulmonary embolism and successfully treated by inserting an inferior vena cava filter and anticoagulant therapy with warfarin [Please confirm whether previous sentence is correct]. However, the lung nodule on thoracic computed tomography was still depicted four months later. With suspicion of a malignant tumor, including possible lung cancer, a right segmentectomy was performed. Pathological assessment of the resected specimen showed the tumor was derived from the right bronchial wall, but was not ruptured into the intratracheal lumen, as well as coexistence with intraalveolar hemorrhage near the tumor. The lung nodule was diagnosed as bronchial schwannoma. Thus, the origin of the hemoptysis was found to be pulmonary embolism due to deep vein thrombosis, and not by bronchial schwannoma, which was also present in the lung.

Background/Aims: Asymptomatic esophageal eosinophilia (aEE) is considered to be a potential precursor of eosinophilic esophagitis (EoE). However, there are few clinical parameters that can be used to evaluate the disease. Therefore, we aimed to clarify the factors involved in the symptoms of EoE by examining the clinicopathological differences between aEE and EoE. Methods: We reviewed 41 patients with esophageal eosinophilia who underwent endoscopic ultrasonography and high-resolution manometry. They were divided into the aEE group (n=16) and the EoE group (n=25) using the Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease score. The patients’ clinicopathological findings were collected and examined. Results: The median Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease score was 3.0 in the aEE group and 10.0 in the EoE group. There was no significant difference in patient characteristics, endoscopic findings and pathological findings. The cutoff value for wall thickening was 3.13 mm for the total esophageal wall thickness and 2.30 mm for the thickness from the surface to the muscular layer (total esophageal wall thickness: 84.0% sensitivity, 75.0% specificity; thickness from the surface to the muscular layer: 84.0% sensitivity, 68.7% specificity).The high-resolution manometry study was abnormal in seven patients (43.8%) in the aEE group and in 12 (48.0%) in the EoE group. The contractile front velocity was slower in the EoE group (p=0.026). Conclusions The esophageal wall thickening in the lower portion of the esophagus is an important clinical factors related to the symptoms in patients with EoE.

In some molecular targeted therapies, skin disorders including acne-like rashes or maculopapular rashes frequently appear, which are often clinically problematic. In Kampo medicine, it has been reported that the combination of jumihaidokuto and orengedokuto (hereinafter called JHT + OGT) is effective for acne. In this study, we report the experiences of JHT + OGT for the treatment of rashes caused by molecular targeted therapies. We extracted patients from June 2013 to June 2017 who took molecular targeted therapies and the treatment with JHT + OGT for skin rashes. The primary endpoint was severity of rashes before and after treatment by JHT + OGT (judged by CTCAE v4.0). In 22 patients (14 males and 8 females), the rashes after treatment with JHT + OGT significantly improved compared with those before treatment (from the median grade of 2 to 1 [p = 0.011]), with 14 cases of improvement, 6 cases of no change, and 2 cases of deterioration. It was suggested that JHT + OGT for skin rashes caused by molecular targeted therapies could be one of the treatment options.

Dynamic X-ray (DXR) is a functional imaging technique that uses sequential images obtained by a flat-panel detector (FPD).This article aims to describe the mechanism of DXR and the analysis methods used as well as review the clinical evidence for its use. DXR analyzes dynamic changes on the basis of X-ray translucency and can be used for analysis of diaphragmatic kinetics, ventilation, and lung perfusion. It offers many advantages such as a high temporal resolution and flexibility in body positioning. Many clinical studies have reported the feasibility of DXR and its characteristic findings in pulmonary diseases. DXR may serve as an alternative to pulmonary function tests in patients requiring contact inhibition, including patients with suspected or confirmed coronavirus disease 2019 or other infectious diseases. Thus, DXR has a great potential to play an important role in the clinical setting. Further investigations are needed to utilize DXR more effectively and to establish it as a valuable diagnostic tool.