We herein report a case of a 19-year-old male patient who presented with traumatic alopecia and was successfully treated with Kampo formulation saikoseikanto (Ikkando). This patient was referred to the Kampo outpatient department of Hoshi General Hospital from a neurosurgery hospital located near his workplace. The reason for the consultation was alopecia with subcutaneous hemorrhage that appeared several days after a blow to his parietal region. The patient presented with kyokyokuman on the right side along with chronic pharyngitis. We suspected that the alopecia was caused by folliculitis, so we prescribed saikoseikanto. The results of this medication were dramatic ; his alopecia and pharyngeal inflammation resolved within three months. His depressive mental state and his irritability improved significantly. We recognized that this Kampo formulation controlled both physical and mental disorders.

We herein report a case of a 72-year-old man who complained of recurrent hyperalgesia in the right big toe, which was successfully treated with the Kampo formulation ninjin’yoeito. The unusual pain felt like being cut with a utility knife whenever his skin was lightly scraped with a toothpick. There was mild tactile loss at this area, however, there were no other sensory disturbances in the sense of pain, cold, or vibration. This patient’s hobby was Iaido, a type of Kendo, which places stress on the soles of the feet. Therefore, we speculated that the clinical disorder in this case was related to his exercise. This patient exhibited a pattern of qi and blood deficiency with qi uprising, which suggested the use of ninjin’yoeito. After taking this Kampo formulation, his abnormal hyperalgesia with coldness in the big toe resolved. There have been no prior reports of ninjin’yoeito effectively treating unusual hyperalgesia.

We herein report the case of a 68-year-old female patient whose branch-type intraductal papillary mucinous neoplasm (IPMN) regressed during thirteen years of Kampo treatment. The Kampo treatment was not aimed at treating IPMN but rather at addressing her complex complaints, such as menopausal disorders, chronic headaches and abdominal pain. During this period, her IPMN was monitored by MRCP every year without any medication or surgical intervention. The regression of IPMN is extremely rare. Therefore, we report this case by presenting the course of MRCP images along with an overview of Kampo treatment over these thirteen years.

Objective: The incidence and mortality rates of endometrial cancer are increasing globally, including in Japan. Quality of cancer care is promoted through guideline adherence. This study aimed to establish quality indicators (QIs) for endometrial cancer and explore the factors contributing to treatment nonadherence. Methods: QIs and pattern-of-care indicators (PCIs) were developed using the Research and Development/University of California Los Angeles modified Delphi method. QIs reflect desirable healthcare patterns, whereas PCIs address treatment areas with lacking evidence.Data from the Hospital-Based Cancer Registry and Diagnosis Procedure Combination Survey were used. Patients diagnosed or treated between January 1 and December 31, 2020 were included. The reasons for nonadherence were collected. Logistic regression was used to analyze the factors influencing adherence, including age, body mass index, comorbidities, facilities, and recurrence risk. Results: Of the 35 proposed QI candidates, 8 QIs and 9 PCIs were selected, predominantly focusing on surgical aspects. Adherence rates varied, with peritoneal lavage cytology being the highest (93.1%), and postoperative hormone replacement therapy (HRT) for patients aged <45 years being the lowest (30.9%), when focusing on process indicators. Reasons for nonadherence included patient preference and medical comorbidities as significant factors. Multivariate analysis highlighted age, clinical stage, and Barthel index as significant contributors to nonadherence. Conclusion We developed QIs to comprehensively assess endometrial cancer treatment.Adherence rates are favorable; however, HRT has a low adherence rate. Factors leading to nonadherence include advanced age and incomplete activities of daily living, particularly in advanced stages.

Background/Aims: Leucine-rich α-2-glycoprotein (LRG) is a new serum biomarker reflecting the disease activity of ulcerative colitis (UC), but its change during the acute phase has not been enough investigated. Methods: Patients with UC who initiated the induction therapy with steroid or advanced therapy (biologics or Janus kinase inhibitors) were prospectively enrolled. Associations of LRG, C-reactive protein (CRP) and fecal calprotectin (FC) at baseline, week 1, and week 8 with clinical remission at week 8 and subsequent endoscopic improvement within 1 year (Mayo endoscopic subscore of 0 or 1) were assessed. Results: A total of 143 patients with UC were included. LRG and CRP at week 1 were significantly lower in the clinical remission group than in the non-remission group (LRG, 20.6 μg/mL vs. 28.4 μg/mL, P< 0.001; CRP, 0.9 mg/dL vs. 2.3 mg/dL, P< 0.001) while FC demonstrated the difference between groups only at week 8. The area under the curves of week 1 LRG, CRP, and FC for week 8 clinical remission using the receiver operating characteristic curves analysis were 0.68, 0.71, and 0.57, respectively. Furthermore, LRG and CRP predicted subsequent endoscopic improvement as early as week 1, while FC was predictive only at week 8. Conclusions LRG can be an early-phase biomarker predicting subsequent clinical and endoscopic response to induction therapy.

We herein report three patients who complained atypical febrile diseases associated with painful whole body (Case 1), general fatigue (Case 2), and a sense of general discomfort (Case 3). All cases were not accompanied by dizziness and a shaky feeling which are commonly associated in shimbuto-sho i.e. indication of shimbuto, but presented severe tenderness at the left paraumbilical region which was suggested as indicative point of shimbuto by Yoshiko Takagi. We made a diagnosis in these three cases as shimbuto-sho based on the Takagi's tender point. Through these clinical experiences we propose that a new type of shimbuto-sho, which are completely different from the fixed idea of inherited knowledge. This new type of shimbuto-sho consists of following signs ; fever with chill, floating and feeble pulse, no sweating, general fatigue or body pain, and severe pain at Takagi's tender point.

We began providing comprehensive cardiac rehabilitation for congestive heart failure (CHF) in 2014 at our institution, using an original pamphlet and heart failure notebook to provide life guidance for CHF. However, the life guidance rate was lower in 2017 (61%) than it was in 2014 (77%). The objective of this study was to investigate the awareness of life guidance among nurses. We administered a questionnaire survey regarding life guidance to 28 nurses in December 2018. Among the 27 respondents, 26 nurses (96%) had high motivation and 21 (80%) felt a sense of accomplishment. Responses to the “most important point in life guidance” were “understanding living condition” by 14 nurses, “heart failure notebook” by 9 nurses, and “guidance using the pamphlet” by 6 nurses. Fifteen nurses (58%) felt that the guidance had become routine in nature, and 5 nurses (19%) were worried about their instruction. The nurses were motivated to provide life guidance, but they also felt that the guidance had become routine because they had been providing the same guidance for many years. We consider that the factors related to the lower life guidance rate are the routine/repetitive nature of the guidance and concerns about instruction. Going forward, we need to review the content of the guidance and the teaching approach.

Background: With the expanding use of social media, medical students have been posting an increasing amount of content that against ethics and professionalism.　Objective: To develop a checklist for social media use within medical education based on our national survey.　Methods: We analyzed and classified unprofessional behaviors that occurred over the past ten years in Japan. Then, we developed an event-based checklist for the use of social media use.　Result: The behaviors violating ethics and professionalism were classified into 3 categories. We have developed a social media checklist consisting of 10 items.　Discussion: Since social networking services are becoming vital information technology, every medical student or professional may risk unprofessional behaviors when they post or exchange any professional information. We propose appropriate education using an event-based checklist for social media usage.

Introduction: To implement effective medical education, it is important to clarify the process of recognizing and comprehending medical terms.　Methods: We conducted a questionnaire survey of 492 first- to fifth-year medical students to evaluate the recognition and comprehension rates of 57 medical terms in each grade. The terms were classified using the hierarchical cluster analysis based on the recognition and comprehension rates.　Results: The response rate was 91.1% (n=448). The 57 terms were classified into the following five clusters: #1, 30 terms that the students recognized and comprehended from Y1; #2, 18 terms that the students recognized from Y1 and comprehended as the grade increased; #3, six terms that the students recognized and comprehended as the grade increased; #4, two terms that the students recognized from Y1 but had not comprehended even in upper grades; #5, one term that the students recognized as the grade increased but had not comprehended even in Y5.　Discussion: Teachers may need to devise educational strategies while considering different patterns of students’ recognition and comprehension of medical terms.