A 50-year-old female developed severe dermatitis on her face during topical therapy with Shiun-ko and Taitsu-ko. The skin lesions almost disappeared in two weeks with oral steroid therapy and did not recur. Patch testing showed positive reactions to Shiun-ko, Taitsu-ko and Lithospermi radix, and beeswax, which were constituents of Shiun-ko and Taitsu-ko. The result suggests that the patient was sensitized with these topical medicaments and developed allergic contact dermatitis.

Poor circulation is considered to be a cause of stiff shoulders, but there have been no studies on deep hemodynamics and the subjective estimation/palpation of stiff shoulders. We evaluated the relationship between deep hemodynamics and the degree of the subjective estimation/palpation of stiff shoulders by near-infrared spectrophotometry.
The subjects were 146 patients who visited our center and 23 healthy volunteers. Deep hemodynamics (tissue oxygen saturation: StO₂, total hemoglobin concentration: total Hb) was measured in the scapular region of the bilateral shoulders using a deep hemodynamics measurement system (PSA-IIIN, Biomedical Science), and its relationship with the severity of the subjective estimation of stiff shoulders (5-grade rating) and that of palpation (4-grade rating) was evaluated. Deep hemodynamic values were affected by the body mass index (BMI) that is highly correlated with subcutaneous fat thickness. Therefore, analysis was performed in 70 patients and 8 healthy volunteers with BMI of 20-24 that does not affect hemodynamic values. Compared with the healthy volunteers, patients who reported marked shoulder stiffness showed a significant decrease in total Hb, and that who reported shoulder stiffness showed a significant decrease in StO₂. On the other hand, compared with the healthy volunteers, patients with marked shoulder stiffness observed by palpation showed significant decreases in both StO₂ and total Hb; the decreases were more marked with more marked stiffness. These results suggested that deep hemodynamics is a diagnostic parameter of stiff shoulders.

In the aftermath of disasters in areas where populations live in close proximity and where sanitation and water supplies are compromised, an environment is created which is conducive to epidemics of vaccine-preventable diseases.
A strong earthquake occurred in Haiti in January 2010, severely affecting Port au Prince, the capital of the country, and the Government was functionally damaged. Over 220,000 people lost their lives and over 300,000 were injured.
Around 1.3 million people are living in temporary shelters in the Port-au-Prince metropolitan area and over 500,000 people have left the disaster areas to seek refuge in the rest of the country.
In Haiti, one of the world's most impoverished countries, the weak routine vaccination coverage was noted and the vaccination campaign was concerned as one of the first priorities.
The Japanese Red Cross (JRC) sent a medical team, called an ERU (Emergency Response Unit) right after the earthquake and provided medical services such as clinics in affected areas.
At the same time, we were involved in the vaccination campaign as one of the key players in the International Federation of the Red Cross and Red Crescent Societies (IFRC) in responding to the mass vaccination campaign by the Ministry of Health supported by WHO (World Health Organization) and UNICEF.
More than 150,000 people were vaccinated in 1 month by all Red Cross members. 35,217 of them were by JRC and the coverage was 75.5% according to the random survey. Including all the activities, it took more than 3 months and 62% of initially estimated population was vaccinated until the end.
After disasters, people typically move to other places seeking a better environment so mass vaccination campaign has to be carried out immediately, once it is decided upon. The selection of target populations, vaccines and good cooperation with other organizations is the key to success.

Nobody studies economic evaluation of acupuncture and moxibustion in Japan. To establish a method of economic evaluation of acupuncture and moxibustion, we introduced case study of economic evaluation of acupuncture and moxibustion at work. In addition, we examined a course of study that annex economic evaluation to a study of acupuncture and moxibustion. This manuscript introduces two case studies of economic evaluation and essential points of economic evaluation.

Objective : To research reports of economic analysis of acupuncture therapy.
Method : Searches were performed in Medline for reports of cost description, economic, randomized controlled trial, cost effectiveness, or cost benefit. Studies were included if they reported original data from any form of standard economic analysis.
Results : A total of 15 papers was found. These studies were investigated as follows : angina pectoris, carpal tunnel syndrome, stroke, knee osteoarthrosis, low back pain, musculoskeletal disease, migraine, acupuncture analgesia. On the other hand, only one paper was found in Japan.
Conclusion : Almost studies were noncntrolled trial, non-rigorous and retrospective studies. In future there is a need for high quality and rigorous studies of the cost and benefits of acupuncture.

Objective : Risk factors for SSI after open heart surgeries were evaluated in relation to a bundle of SSI preventive measures. Methods : Research design is a retrospective cohort study. The study population was 1,579 patients who had received open heart surgeries at Kobe City Medical Center General Hospital from January 2008 to December 2010 (Period I : when standard infection prevention measures were implemented) and from January 2014 to December 2016 (Period II : after a relocation of the hospital to a new campus and enhanced infection prevention measures were implemented). Factors associated with SSI were determined using univariate modelling analysis followed by multi-variate logistic regression analysis. The Center for Disease Control and Prevention definition of SSI was used for case determination. Results : Overall SSI incidence was 4.5%. SSI incidence decreased significantly from 6.6% in Period I to 2.9% in Period II (p＜0.001). Significant improvement in adherence to the recommended preventive measures was observed in Period II in selection of appropriate antibiotics, discontinuation of prophylactic antibiotics within 72 h after surgery and glucose control on post-operative Day 1 and 2 (p＜0.001). A univariate analysis showed statistical significance in surgical procedure, surgical period, surgical duration, post-operative day 2 morning glucose level, administration of prophylactic antibiotics within 1 h before incision, 100% compliance with the Bundle. Complex surgery (odds ratio 2.5 ; 95%CI 1.3～4.8) were identified as a risk factor by multiple logistic regression. Surgical period (Period II, odds ratio 0.41 ; 95%CI 0.28～30.71) and administration of prophylactic antibiotics within 1 h before incision (odds ratio 0.57 ; 95%CI 0.33～0.97) reduced SSI risks. Conclusion : The study demonstrated administration of prophylactic antibiotics within 1 h before incision was particularly important for SSI prevention. Higher compliance with SSI bundle and a special attention to patients receiving complex surgery were also warranted.