Introduction: Calciphylaxis is a rare disorder characterized by painful ischemic skin ulcers. There is currently no approved therapy and its pain management is often challenging. Case: A 40-year-old female was diagnosed with calciphylaxis seven years after starting hemodialysis. Despite the administration of sodium thiosulfate intravenous and intralesional combination therapy, the ulcers progressed on both lower limbs and buttocks. She suffered from terrible and opioid refractory pain due to ulcers. After careful consideration of the appropriateness, a lumbar sympathetic ganglion block (LSGB) was performed. Six months later, all the ulcers had re-epithelialized and she was relieved of pain. Conclusion: While the appropriateness of LSGB must be carefully evaluated, it could be a treatment option for patients with central-type calciphylaxis.

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.

The role of academic journals evolves with the times. Academic publishing is diversifying, shifting from traditional paper-based formats to broader dissemination through open access. In response to these developments-and to contribute to ongoing progress in medical education-Medical Education (Japan) has undertaken a comprehensive revision of its submission guidelines. As of January 17, 2025, all submissions, peer reviews, and editorial processes are being conducted in accordance with the updated guidelines.　The Editorial Board convened a round-table discussion to explore recent developments, beginning with the revision of the submission guidelines. This discussion elaborates on the journal's role and its relevance to the academic community, including society members, authors, and readers. It features statements from participating editorial committee members and highlights the key issues discussed, including the criteria each member uses to evaluate manuscripts. The aim is to offer insight into the journal's editorial stance and decision-making process.

Background/Aims: Immune checkpoint blockade has recently been reported to be effective in treating microsatellite instability (MSI)-high tumors. Therefore, sufficient sampling of histological specimens is necessary in cases of unresectable pancreatic cancer (UR-PC). This multicenter study investigated the efficacy of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) using a Franseen needle for MSI evaluation in patients with UR-PC. Methods: A total of 89 patients with UR-PC who underwent endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) or EUS-FNB using 22-G needles at three hospitals in Japan (2018–2021) were enrolled. Fifty-six of these patients (FNB 23 and FNA 33) were followed up or evaluated for MSI. Patient characteristics, UR-PC data, and procedural outcomes were compared between patients who underwent EUS-FNB and those who underwent EUS-FNA. Results: No significant difference in terms of sufficient tissue acquisition for histology was observed between patients who underwent EUS-FNB and those who underwent EUS-FNA. MSI evaluation was possible significantly more with tissue samples obtained using EUS-FNB than with tissue samples obtained using EUS-FNA (82.6% [19/23] vs. 45.5% [15/33], respectively; p<0.01). In the multivariate analysis, EUS-FNB was the only significant factor influencing the possibility of MSI evaluation. Conclusions EUS-FNB using a Franseen needle is desirable for ensuring sufficient tissue acquisition for MSI evaluation.

Vascular ring is a congenital anomaly of the aorta and its branches that compresses the trachea and/or esophagus. Infants with vascular ring may have critical dyspnea due to airway obstruction, which is called a dying spell. In addition, vascular ring leads to secondary malacia of the trachea and bronchus. To prevent dying spells and progression of malacia, vascular ring should be diagnosed as soon as possible. We report here a case of a 5-month-old girl with vascular ring affecting the right aortic arch, aortic diverticulum, and ligamentum arteriosum. She had stridor from birth and afebrile convulsions due to dying spells at 5 months of age. Transthoracic echocardiography revealed right aortic arch, and plain computed tomography (CT) revealed severe tracheal stenosis. Finally, we diagnosed vascular ring based on contrast-enhanced CT imaging. We should consider vascular ring when we encounter infants with stridor. Echocardiography is helpful for examining the structure of aorta, and if an aortic anomaly is noted, contrast-enhanced CT should be performed to diagnose vascular ring immediately.

  In the health resorts of Germany, the empirical effects of the unique natural capital and environment on humans are verified by scientific methods such as medicine, meteorology, and chemistry, and then approved as therapeutic drugs. Natural capital is provided in various forms for the maintenance of health, treatment of diseases, and recovery from fatigue and stress. Natural capital include hot springs, natural gases, and peloid (from the soil), as well as climate and oceans. The categorization of health resorts is defined by the type and quality of natural capital available. Due to their unique characteristics, a system that allows users to select the health resorts that suit their specific needs has been established, enabling them to utilize natural capital effectively for health promotion.  Considering the current state of Japan, country with an abundance of natural capital that is considered underutilized, we visited Bad Homburg and six health resorts located in Germany’s Black Forest located in the southwestern part of the country to learn about the current state of their health resorts.  All the health resorts we visited were excellent centers certified by the German Spas Association and German Tourism Association. Bad Wildbad and Keidel Mineral-Thermalbad, both thermal health resorts, maintain the provision structure for medical treatment and tourism. Against a background of growing interest in the environment, they utilize the land and natural capital to their advantage by incorporating the elements of trendiness, fun, and excitement to revitalize the local and the health resorts’ communities.  Due to the differences in the structure, environment, and systems between the hot springs in Japan and those in Germany, it would not be easy to apply the current state of the German health resorts to similar resorts in Japan. However, Japan is rich in natural environments such as forests and hot springs and is blessed with a quantity and diversity comparable to that of Germany’s Black Forest. Therefore, we believe that there is potential for further utilization of Japan’s natural capital for health promotion. The efforts of the German health resorts could direct and inspire us.

We have previously reported on a predictive model for deficiency-excess pattern diagnosis that was unable to predict the medium pattern. In this study, we aimed to develop predictive models for deficiency, medium,and excess pattern diagnosis, and to confirm whether cutoff values for diagnosis differed between the clinics. We collected data from patients' first visit to one of six Kampo clinics in Japan from January 2012 to February 2015. Exclusion criteria included unwillingness to participate in the study, missing data, duplicate data, under 20 years old, 20 or less subjective symptoms, and irrelevant patterns. In total, 1,068 participants were included. Participants were surveyed using a 153-item questionnaire. We constructed a predictive model for deficiency, medium, and excess pattern diagnosis using a random forest algorithm from training data, and extracted the most important items. We calculated predictive values for each participant by applying their data to the predictive model, and created receiver operating characteristic (ROC) curves with excess-medium and medium-deficiency patterns. Furthermore, we calculated the cutoff value for these patterns in each clinic using ROC curves, and compared them. Body mass index and blood pressure were the most important items. In all clinics, the cutoff values for diagnosis of excess-medium and medium-deficiency patterns was > 0.5 and < 0.5, respectively. We created a predictive model for deficiency, medium, and excess pattern diagnosis from the data of six Kampo clinics in Japan. The cutoff values for these patterns fell within a narrow range in the six clinics.

In the treatment of climacteric disorders, evaluation of menopausal women based on personal and overall aspects of their sho condition has been found to be useful. This form of treatment is considered particularly useful for patients who cannot, or do not wish to use hormone replacement therapy (HRT). In this paper, we present the cases of patients who were assessed using sho and the Kampo medical index, and given successful treatment using kuoketsuzai (drugs for overcoming oketsu) and yokukansankachinpihange.