Fever is a major symptom of Kawasaki disease, occurring in 99.5% of patients. We report a case of coronary artery aneurysms without fever in an 8-month-old male infant, who was referred to our department on the 8th day of illness for evaluation of red eyes and erythema at the BCG vaccination site. On the 16th day of illness, he was referred again to our department with membranous debris on his fingers. Cardiac ultrasonography revealed coronary artery aneurysms (#1, 3.9mm [Z=6.68]; #5, 3.3mm [Z=4.96]), and we diagnosed incomplete Kawasaki disease. Coronary angiography performed at the age of 1 year (3 months after disease onset) showed regression of coronary artery aneurysms #1 and #5 to 2.1mm (Z=2.12) and 2.1mm (Z=1.33), respectively; therefore, administration of anticoagulants and antiplatelet agents was discontinued. Considering the possibility of incomplete Kawasaki disease, comprehensive evaluation of coronary artery lesions is warranted even in afebrile patients who present with red eyes and erythema at the site of the BCG inoculation.

  Positive Deviance (PD) is based on the observation that in every community there are certain individuals or groups whose uncommon behaviors and strategies enable them to find better solutions to problems than their peers, while having access to the same resources and facing similar or worse challenges. Developed in 1990 by Save the Children to improve child nutrition in Vietnam, the PD approach has gained traction among development partners for various international development projects. This paper discusses how the PD approach and the Logical Framework Approach can be integrated in global health projects.  The PD approach is effective for projects targeting behavior change, such as those aiming to improve nutrition, reduce infant mortality, promote reproductive health, and prevent non-communicable diseases. To integrate PD with the Logical Framework Approach, projects should create a logic model outlining inputs, activities, outputs, outcomes, and impacts. The PD approach should then be incorporated into each stage of this model. An objective that should be achieved through behavior change is defined as Outcome (Project Purpose), and Outputs need to be considered with the governance and the structure of the target societies and organizations as determinant factors for the dissemination of PD practices. Five steps of the PD implementation process, i.e., defining problems, identifying positive deviants, specifying and extracting PD practices, planning and implementing activities, and monitoring and evaluating, can be incorporated in the project as activities. Inputs should emphasize local initiatives, with experts playing supportive roles.  While an increasing number of development partners for low- and middle-income countries have adopted the PD approach, such initiatives are still rare among Japanese organizations. The case presented demonstrates that even small-scale projects can yield significant results, encouraging Japanese colleagues to learn from this experience and consider how to initiate the challenge of applying the PD approach in future projects.

Objective: To clarify the progression of core flexibility and core muscle strength in fresh lumbar spondylolysis before and after the introduction of rehabilitation treatment. Methods: We enrolled 160 patients diagnosed with fresh lumbar spondylolysis based on magnetic resonance imaging findings from September 2019 to December 2022. Posterior Lumbar Flexibility test and Lumbar Locked Rotation test were performed to assess core flexibility. The Kraus-Weber test and Sahrmann Core Stability test were performed to assess core muscle strength. The initial and final evaluations of all tests were compared.Results: All tests showed significant improvement at the final evaluation compared to the initial evaluation.Conclusion: Patients with lumbar spondylolysis often had decreased core flexibility and core muscle strength at the initial evaluation; these parameters improved at the final evaluation owing to rehabilitation treatment.

[Background] Moxibustion has contributed to better health outcomes of the Japanese people. But only a small number of reports are available regarding the current practice of moxibustion in recent years. We therefore surveyed moxibustion practitioners.[Methods] Through academic societies, professional organizations, and other associations related to the disciplines of acupuncture and moxibustion, practitioners were asked to respond to the questionnaire via Google Forms. [Results] Valid responses were obtained from 1,507 practitioners with the following demographics: 67.8% had been engaged in clinical practice for less than 20 years; 71.9% ran their own clinics; 43.6% belonged to academic societies; 69.3% belonged to industrial organizations, etc. The proportion of practitioners conducting various methods of moxibustion were as follows: 66.3% warming moxibustion and 53.4% for heating-through moxibustion, and regarding processed moxibustion, 79.5% included moxibustion with tube and 37.0% used smokeless moxibustion. Regarding the effectiveness of moxibustion, 98.9% responded as "highly effective" or "moderately effective." The proportion of respondents who experienced "patient's refusal of moxibustion" was 45.6% before patients experienced moxibustion and 33.2% after their experience. The patients refused it primarily because of "heat," "burns," and "uncomfortableness with smoke." Regarding the activities necessary to promote the spread of self-care moxibustion, "proving effectiveness through clinical research" (75.6%), "providing scientific evidence through basic research" (68.3%), and "awareness-building activities" (63.9%) were indicated among 1,495 respondents.[Discussion] The survey revealed that, due to the shift in societal awareness, there is also a shift in the use of moxibustion from direct moxibustion to more indirect moxibustion. Many clinical practitioners of moxibustion conducted the therapy because they considered it effective. The survey reconfirmed that heat, burns, and smoke represent major reasons why patients do not want to receive the moxibustion therapy. The challenging issues to be addressed for the purpose of spreading and developing moxibustion include maintenance of "safety," research to prove "clinical efficacy" and provide "scientific evidence," and "awareness-building activities."

Objective: Almost half of all patients with cancer experience dyspnea, which can have various causes. Although systemic corticosteroids are administered to relieve symptoms, their efficacy has not been established. This systematic review aims to determine the efficacy of systemic corticosteroids for dyspnea in patients with cancer. Methods: CENTRAL, MEDLINE, EMBASE, and Ichushi-Web databases were searched for articles published from their inception to September 23, 2019, on studies of systemic corticosteroid administration for dyspnea in patients with cancer. The primary outcome measure was dyspnea intensity, as assessed by patient-reported outcomes. Secondary outcome measures were quality of life, delirium, and severe adverse events. Results: Two RCTs were included in the meta-analysis. With regard to alleviating dyspnea, the systematic corticosteroid group was associated with significantly greater dyspnea relief than the placebo group (mean difference: −0.71 [95% CI: −1.4 to −0.03]). However, a meta-analysis of quality of life and delirium could not be performed due to insufficient data. Analysis of severe adverse events showed no significant difference in their incidence between the corticosteroid and control groups (relative rate: 0.96 [95% CI: 0.19-4.93]). Conclusions: Systemic corticosteroids may be effective in treating dyspnea in patients with cancer, particularly those with lung involvement. Limiting the conditions for which corticosteroids are approved is expected to promote their appropriate use and minimize their adverse effects. However, further investigation is needed to determine the appropriate dosage, and the conditions in which corticosteroids are effective.

Autoimmune pancreatitis (AIP), which is considered the pancreatic expression of a systemic immunoglobulin G4-related disease, is characterized by excessive infiltration of plasmacytes bearing immunoglobulin G4 and a unique form of fibrosis in multiple organs. This relatively new disease entity has garnered great attention from clinicians, but its pathophysiology remains poorly understood. Recent discoveries indicate that plasmacytoid dendritic cell activation followed by robust production of type I interferon and interleukin-33 plays a key role in driving chronic fibro-inflammatory responses in both murine and human AIP. Furthermore, the compositional alterations in the gut microbiota, known as intestinal dysbiosis, triggered plasmacytoid dendritic cell-driven pathogenic type I interferon responses. Intestinal dysbiosis is associated with a breakdown in intestinal barrier function; thus, we examined whether the latter condition affects the development of experimental AIP. Our recent research has revealed that intestinal barrier disruption worsens experimental AIP by facilitating the translocation of pathogenic bacteria, such as Staphylococcus sciuri, to the pancreas from the gut. These results indicate the “gut-pancreas axis” underlies the immunopathogenesis of AIP, and the maintenance of intestinal barrier integrity can prevent the worsening of AIP by inhibiting pancreatic colonization by harmful gut bacteria. In this mini review, the interactions between AIP development and gut microbiota are discussed with the aim of providing useful information not only for researchers but also for clinicians.