[Purpose] Electrical acupuncture at the pudendal nerve was employed to treat perineal discomfort in two patients with chronic pelvic pain syndrome (CPPS), and the effectiveness was evaluated using a visual analogue scale (VAS).
[Methods] The patients were 67 and 65 years of age, respectively, when they were referred to the Meiji College of Oriental Medicine because of ineffective medical management of CPPS. Acupuncture at the BL-33 (Zhongliao) point and electrical acupuncture at the pudendal nerve were applied to treat symptoms of CPPS. Pain, discomfort, lower urinary tract symptoms and quality of life were evaluated using the National Institutes of Health Chronic Prostatitis Symptom Index, the International Prostate Symptom Score and a Visual Analogue Scale.
[Results] Acupuncture at BL-33 was not effective in improving the perineal discomfort of CPPS. However, the symptom was improved dramatically after electrical acupuncture to the pudendal nerve, and the effectiveness was demonstrated by VAS.
[Conclusions] Electrical acupuncture at the pudendal nerve may be effective in the treatment of pudendal discomfort due to CPPS. VAS was useful in evaluating improvements in pudendal discomfort.

[Objective]To evaluate the effectiveness of moxibustion treatment for patients with nocturia in a randomized controlled trial.
[Methods]Subjects were 36 patients with refractory nocturia, randomly allocated to a moxibustion group (n = 20) and a sham moxibustion group (n = 16). Moxibustion treatment to Chung-Chi (CV3) was performed three times/day for one week by the patients themselves. The average number of nocturia in the week before and the week during moxibustion treatment were compared between groups.
[Results]The average number of nocturia during moxibustion was significantly decreased in the moxibustion group compared to that before treatment. No significant change was seen in the sham moxibustion group.
[Conclusion]Moxibustion treatment appears to reduce the average number of nocturia. Moxibustion to Chung-Chi seems to represent an effective therapeutic option for nocturia.

[Objective]To evaluate the effects of acupuncture treatment for refractory urinary urgency and incontinence after radical prostatectomy.
[Methods]Three patients who had urinary urgency and/or urinary incontinence four months after radical prostatectomy received acupuncture at the BL33(Zhongliao) point. Acupuncture was performed once per week for four weeks. Symptoms were assessed by the International Prostate Symptom Score, IPSS QOL index for subjective evaluation and Frequency-Volume chart for objective evaluation.
[Results]After acupuncture treatment, urinary urgency and urge incontinence were improved, however stress urinary incontinence persisted. The scores for IPSS and IPSS QOL index were improved. Frequency-Volume charts showed that voided volume was increased and frequency of urination decreased after acupuncture treatment.
[Conclusions]Acupuncture at the BL33point might be a useful treatment option for urinary urgency and urge incontinence after radical prostatectomy.

Introduction: No formal curriculum has been formulated for teaching behavioral science to undergraduate medical students in Japan.
Method: We conducted a survey using the Delphi method to investigate the required competency in behavioral science for graduates in medicine. Then, we developed an outcome-oriented curriculum for teaching behavioral science.
Results: We propose an educational module of behavioral science consisting of 15 sessions of 90-minute lectures, small group discussions, and practice.
Discussion: We recommend including not only lectures but also practices according to problem-based learning as well as team-based learning in the curriculum to achieve the target outcome.

Objective: Municipal National Health Insurance (NHI) in Nagasaki Prefecture in Japan struggles with poor attendance of health check-ups, which was only 39.6% in 2018. This study aimed to evaluate factors that encourage healthy behaviors, including opting for health check-ups, and the characteristics of middle-aged and older individuals who did not undergo health check-ups.Materials and Methods: This cross-sectional study, using a self-administered questionnaire, was conducted in August 2020 in three municipalities of Nagasaki Prefecture. In addition to questions regarding sociodemographic information, such as sex, age, educational status, self-rated economic status, and family structure, the questionnaire included questions on daily lifestyle habits such as alcohol intake and exercise, current medical treatment, self-rated health, and information related to health check-ups. Of the 18,710 questionnaires distributed in the three municipalities, 8,756 (46.8%) were collected by the end of December 2020, of which 7,840 were valid for analysis. The compliance rate for health check-ups was obtained from the Public Health and Welfare Bureau of Nagasaki Prefecture. Statistical analyses were performed according to two age groups: 40−59 and 60−74 years.Results: Among the respondents who did not undergo health check-ups in the year prior to this study, “lack of time” and being “too bothersome” were the most popular reasons for not attending health check-ups. “Living alone” and “low self-rated economic status” were negative factors for receiving health check-ups regardless of age group.Conclusions: Vulnerable middle-aged and older persons, such as those living alone and with low economic status, were less likely to undergo health check-ups. Emphasis on home visits by public health nurses may also be needed to increase awareness of individual health conditions, especially for people living alone and those who are socioeconomically disadvantaged.

Background/Aims: Endoscopic submucosal dissection (ESD) for residual or recurrent colorectal lesions after incomplete resection is challenging because of severe fibrosis. This study aimed to compare the efficacy of the pocket-creation method (PCM) with a traction device (TD) with that of conventional ESD for residual or recurrent colorectal lesions. Methods: We retrospectively studied 72 patients with residual or recurrent colorectal lesions resected using ESD. Overall, 31 and 41 lesions were resected using PCM with TD and conventional ESD methods, respectively. We compared patient background and treatment outcomes between the PCM with TD and conventional ESD groups, respectively. The primary endpoints were en bloc resection and R0 resection rates. The secondary endpoints were the dissection speed and incidence of adverse events. Results: En bloc resection was feasible in all cases with PCM with TD, but failed in 22% of cases of conventional ESD. The R0 resection rates for PCM with TD and conventional ESD were 97% and 66%, respectively. Dissection was significantly faster in the PCM with TD group (13.0 vs. 7.9 mm2/min). Perforation and postoperative bleeding were observed in one patient in each group. Conclusions PCM with TD is an effective method for treating residual or recurrent colorectal lesions after incomplete resection.

Background: Cell blocks (CBs) from pleural fluid are frequently used in the practice of respiratory medicine, but there have been few reports on the use of CBs from forceps and brush washing fluid in bronchoscopy for pathological diagnosis. We retrospectively analyzed the usefulness of CBs from forceps and brush washing fluid. 　Patients and Methods: Patients who underwent bronchoscopy and had CBs made from forceps and brush washing fluid in bronchoscopy at our institution between June 2016 and May 2021 were included. Cases in which additional information was obtained from CBs were reviewed in detail. 　Results: In total, 138 patients had CBs made from forceps and brush washing fluid in bronchoscopy during the study period. EBUS-GS (endobronchial ultrasound-guide sheath) was used for 102 of these patients. The final diagnosis was lung cancer in 114 cases, infection disease in 10 cases, metastatic lung tumor in 8 cases, lymphoproliferative disease in 2 cases, sarcoidosis in 1 case, and organizing pneumonia in 1 case. There were 13 cases with additional information obtained from CBs, all of which were cases of malignant tumors. 　Conclusions: CBs from forceps and brush washing fluid in bronchoscopy were useful for pathological diagnosis in some cases.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is useful for diagnosing mediastinal lymph node lesions. Cell blocks prepared from the needle washing fluid and flow cytometry of tissue samples are helpful in making the diagnosis, but the combination of both examinations is not routinely performed. A 77-year-old woman with fever, dyspnea, and anorexia was admitted to our hospital. Computed tomography showed enlarged mediastinal lymph nodes with calcification and left ureteral calculus; however, no focus of infection was identified. We suspected lymph node tuberculosis or malignant lymphoma, and EBUS-TBNA was performed to evaluate the mediastinal lymph node lesions. Because a cell block prepared from the needle rinse fluid was suspicious for malignant lymphoma, we changed the puncture needle from 22 G to 19 G and performed a second EBUS-TBNA. Diffuse large B-cell lymphoma (DLBCL) was diagnosed based on the results of flow cytometry of the EBUS-TBNA samples. Here we report this case of DLBCL in which mediastinal lymph node tuberculosis was suspected and cell block preparation and flow cytometry using EBUS-TBNA specimens were useful for the diagnosis.