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Coronavirus disease 2019 (COVID-19) has become a pandemic, and vaccines remain the only effective tools available for ending it. However, their side effects, such as syncope, which mimics sudden cardiac death, are serious concerns. We herein report 6 cases of delayed vasovagal syncope and presyncope (VVR) caused by COVID-19 vaccination among 25,530 COVID-19 patients. The prevalence of delayed VVR due to COVID-19 vaccination was 0.026%. In addition, no delayed VVR was found among 17,386 patients who received the influenza vaccine. Delayed VVR is likely to be overlooked if medical staff are not aware of this symptom. This report provides significant information regarding effects of COVID-19 vaccination.

Aims Inflammation is involved in various processes of atherosclerosis development. Serum C-reactive protein (CRP) levels, a predictor for cardiovascular risk, are reportedly reduced by statins. However, several studies have demonstrated that CRP is a bystander during atherogenesis. While S100A12 has been focused on as an inflammatory molecule, it remains unclear whether statins affect circulating S100A12 levels. Here, we investigated whether atorvastatin treatment affected S100A12 and which biomarkers were correlated with changes in arterial inflammation. Methods We performed a prospective, randomized open-labeled trial on whether atorvastatin affected arterial (carotid and thoracic aorta) inflammation using 18fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) and inflammatory markers. Thirty-one statin-naive patients with carotid atherosclerotic plaques were randomized to either a group receiving dietary management (n=15) or one receiving atorvastatin (10mg/day, n=16) for 12weeks. 18F-FDG-PET/CT and flow-mediated vasodilation (FMD) were performed, the latter to evaluate endothelial function. Results Atorvastatin, but not the diet-only treatment, significantly reduced LDL-cholesterol (LDL-C, -43%), serum CRP (-37%) and S100A12 levels (-28%) and improved FMD (+38%). 18F-FDG-PET/CT demonstrated that atorvastatin, but not the diet-only treatment, significantly reduced accumulation of 18F-FDG in the carotid artery and thoracic aorta. A multivariate analysis revealed that reduction in CRP, S100A12, LDL-C, oxidized-LDL, and increase in FMD were significantly associated with reduced arterial inflammation in the thoracic aorta, but not in the carotid artery. Conclusions Atorvastatin treatment reduced S100A12/CRP levels, and the changes in these circulating markers mirrored the improvement in arterial inflammation. Our observations suggest that S100A12 may be an emerging therapeutic target for atherosclerosis.

Background The clinical characteristics of IgG4-related sclerosing cholangitis (IgG4-SC) especially without autoimmune pancreatitis (AIP) have not been investigated in a large cohort. Aims To clarify the clinical characteristics of IgG4-SC and IgG4-SC without AIP. Methods We retrospectively reviewed imaging, serology, other organ involvement (OOI) and histology of 872 patients with IgG4-SC who participated in a Japanese nationwide survey in 2019, and compared these items between IgG4-SC with and without AIP. Results AIP was present in 83.7% (730/872) of IgG4-SC. In IgG4-SC, bile duct wall thickening was observed on ultrasound (528/650; 81.2%), computed tomography (375/525; 71.4%) and magnetic resonance imaging or cholangiopancreatography (290/440; 65.9%). An elevated serum IgG4 level (≥ 135 mg/dL) was found in 88.0% (322/366). IgG4-related OOI other than AIP was observed in 25.2% (211/836). The proportion of females was significantly higher in IgG4-SC without AIP (28.9% vs. 20.1%; p = 0.025). Hilar stricture was the most common cholangiographic type in IgG4-SC without AIP (39/107; 36.4%).There were no significant differences between IgG4-SC with and without AIP in the rates of bile duct wall thickening, elevated serum IgG4 level, or IgG4-related OOI. Conclusions The clinical characteristics of IgG4-SC was similar between IgG4-SC with and without AIP in a large cohort.

Purpose 18F-Fluorodeoxyglucose positron emission tomography/computed tomography fusion imaging (18F-FDG PET/CT) is an important diagnostic tool in breast cancer. The utility of maximum standardized uptake values (SUVmax) of primary tumors has been evaluated to predict sentinel node (SN) and non-SN metastasis in clinically node-negative (cN0) patients. Patients and Methods 18F-FDG PET/CT was performed on 414 cN0 patients. The following parameters were evaluated: SUVmax at 60 min (SUVmax1), SUVmax at 120 min (SUVmax2), percent change between SUVmax1 and SUVmax2 (ΔSUVmax%), SN metastasis foci maximum size (SN meta size), and ratio of metastatic SNs to total SNs or SN ratio (SNR). It was assessed whether these were risk factors for SN metastasis. The relationship between these parameters and the status of SN and/or non-SN metastasis was retrospectively explored to predict non-SN metastasis. Results All SUV parameters significantly correlated with pathological T factor (pT), nuclear grade, lymphatic invasion (Ly), and Ki-67 labeling index. On multivariate analysis, pT and Ly were independent predictive factors for SN metastasis. In SN meta-positive cases, SN meta size, SNR, and ΔSUVmax% were predictors for non-SN metastasis on univariate analyses, and the former two were independent predictors on multivariate analysis. The combination of SUVmax2 and ΔSUVmax% was an independent predictor of non-SN metastasis (P = 0.0312) and was associated with prediction of non-SN metastasis negative status with high probability (92.3%). Conclusions In patients with cN0 breast cancer, SUV parameters of the primary tumor were correlated with pathological features. The combination of SUVmax2 and ΔSUVmax% may be useful for predicting non-SN metastasis.

The aim of this study was to propose a method to assess images of the tongue captured using a polarized light camera for diagnostic use in Kampo medicine. Glossy and non-glossy images of the tongue were captured simultaneously using a polarizing camera and a polarizing plate. Data augmentation was performed by modulating the color and gloss, resulting in an increase in the number of images from 11 to 275. To create a data set, the values for which diseases were evaluated by Kampo doctors for all tongue images were taken as the correct values and combined with the features extracted from the tongue images. Using this data set, we constructed a diagnostic support module to evaluate diseases. The resulting mean absolute error of the assessment was 0.44 for qi deficiency, 0.42 for blood deficiency, 0.33 for blood stagnation, 0.36 for yin deficiency, and 0.55 for fluid stagnation, suggesting that the diagnostic assistance module was accurate, and our proposed learning and data augmentation methods were effective.

We herein report a 49-year-old woman with a perivascular epithelial cell tumor (PEComa) of the pancreas. Imaging studies demonstrated a relatively well-demarcated mass, measuring approximately 40 mm in diameter, located in the pancreatic tail. It was heterogeneously enhanced almost to the same degree as the surrounding pancreatic tissue in both the arterial and portal venous phases. We performed endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) using the AcquireⓇ 22-gauge needle and preoperatively obtained a definitive diagnosis with a sufficient sample. Clinicians should consider pancreatic PEComa in their differential diagnosis of patients with a pancreatic mass.

Background A few cases of spontaneous regression of germ cell tumors have been reported. Possible mechanisms include steroid medication, surgical intervention, diagnostic radiation exposure, and immune response. None of these hypotheses has been supported by sufficient data. Case Description Two cases of germinoma demonstrated spontaneous regression before antitumor therapy. In the first case, a 19-year-old man presented with acute hydrocephalus due to a pineal mass and underwent emergent endoscopic third ventriculostomy. The pineal tumor started to regress on the 4th postoperative day after endoscopic third ventriculostomy. In the second case, a 22-year-old man presented with acute hydrocephalus and panhypopituitarism due to a suprasellar mass and underwent emergent external ventricular drainage, biopsy, and septostomy on the day of admission. Apparent regression of the tumor was discovered on the 5th day after initial surgery. Pathologic diagnosis was pure germinoma in both cases. Remarkable accumulations of CD4-positive lymphocytes and some apoptotic cells positive for terminal deoxynucleotidyl transferase–mediated deoxyuridine triphosphate nick end labeling staining were detected in both cases. Diagnostic radiation exposure is the only common condition in all reported cases. Conclusions This unusual phenomenon of spontaneous regression of germinoma may be caused by a combination of pathognomonic characteristics of anatomic location with paraventricular development and stress induction as a trigger, such as salvage surgery or diagnostic radiation, including at extremely low dosage.

An 80-year-old man was admitted due to biliary stricture with autoimmune pancreatitis. Although radiographical examinations suggested Immunoglobulin G4-related sclerosing cholangitis (IgG4-SC), punched biopsies from the bile duct revealed adenocarcinoma. In the resected specimen, abundant N-terminus of Forkhead box P3 (Foxp3)-positive cells were localized in cholangiocarcinoma (CCA) tissue, while IgG4-positive cells were spread around the entire bile duct. Therefore, the case was diagnosed with IgG4-SC accompanied by CCA, not sporadic CCA. We herein report an informative case wherein IgG4-positive cells were abundant in CCA tissue and Foxp3 immunohistochemical staining allowed us to determine that this case had two entities.

Background: Oxidative posttranslational modifications (OPTM) impair the function of Sarcoplasmic/endoplasmic reticulum (SR) calcium (Ca2+) ATPase (SERCA) 2 and trigger cytosolic Ca2+ dysregulation. We investigated the extent of OPTM of SERCA2 in patients with non-ischemic cardiomyopathy (NICM). Methods and results: Endomyocardial biopsy (EMB) was obtained in 40 consecutive patients with NICM. Total expression and OPTM of SERCA2, including sulfonylation at cysteine-674 (S-SERCA2) and nitration at tyrosine-294/295 (N-SERCA2), were examined by immunohistochemical analysis. S-SERCA2 increased in the presence of late gadolinium enhancement on cardiac magnetic resonance imaging. S-SERCA2/SERCA2 and N-SERCA2/SERCA2 correlated with cardiac fibrosis evaluated by Masson’s trichrome staining of EMB. SERCA2 expression modestly increased in parallel with an upward trend in OPTM of SERCA2 with aging. This tendency became prominent only in patients aged >65 years. OPTM of SERCA2 positively correlated with brain natriuretic peptide (BNP) values only in patients aged ≤65 years. Composite major adverse cardiac events (MACE) increased more in the high OPTM group of younger patients; however, MACE-free survival was similar irrespective of the extent of OPTM in older patients. Conclusions: OPTM of SERCA2 correlate with myocardial fibrosis in NICM. In younger patients, OPTM of SERCA2 correlate with elevated BNP and increased composite MACE. Keywords: SERCA2, Oxidative posttranslational modification, Myocardial fibrosis, Non-ischemic cardiomyopathy

We report a case of a 70-year-old man with acute acalculous cholecystitis caused by Giardia lamblia. Contrast-enhanced computed tomography (CT) showed distention of the gallbladder due to a pericholecystic abscess without gallstones. Magnetic resonance cholangiopancreatography and drip infusion cholecystocholangiography-CT demonstrated a stricture of the hilar bile duct and cystic duct obstruction. We conducted transpapillary bile duct brush cytology and a biopsy of the hilar bile duct stricture; numerous active trophozoites of Giardia lamblia were observed without malignant findings. We considered this bile duct lesion to be biliary giardiasis. Biliary giardiasis should be taken into consideration when diagnosing acute acalculous cholecystitis.

Background To evaluate the clinicopathological and prognostic significance of the percentage change between maximum standardized uptake value (SUVmax) at 60 min (SUVmax1) and SUVmax at 120 min (SUVmax2) (ΔSUVmax%) using dual time point 18F-fluorodeoxyglucose emission tomography/computed tomography (18F-FDG PET/CT) in breast cancer. Methods Four hundred and sixty-four patients with primary breast cancer underwent 18F-FDG PET/CT for preoperative staging. ΔSUVmax% was defined as (SUVmax2 − SUVmax1) / SUVmax1 × 100. We explored the optimal cutoff value of SUVmax parameters (SUVmax1 and ΔSUVmax%) referring to the event of relapse by using receiver operator characteristic curves. The clinicopathological and prognostic significances of the SUVmax1 and ΔSUVmax% were analyzed by Cox’s univariate and multivariate analyses. Results The optimal cutoff values of SUVmax1 and ΔSUVmax% were 3.4 and 12.5, respectively. Relapse-free survival (RFS) curves were significantly different between high and low SUVmax1 groups (P = 0.0003) and also between high and low ΔSUVmax% groups (P = 0.0151). In Cox multivariate analysis for RFS, SUVmax1 was an independent prognostic factor (P = 0.0267) but ΔSUVmax% was not (P = 0.152). There was a weak correlation between SUVmax1 and ΔSUVmax% (P R2 = 0.166). On combining SUVmax1 and ΔSUVmax%, the subgroups of high SUVmax1 and high ΔSUVmax% showed significantly worse prognosis than the other groups in terms of RFS (P = 0.0002). Conclusion Dual time point 18F-FDG PET/CT evaluation can be a useful method for predicting relapse in patients with breast cancer. The combination of SUVmax1 and ΔSUVmax% was able to identify subgroups with worse prognosis more accurately than SUVmax1 alone.

Purpose 18F-Fluorodeoxyglucose positron emission tomography/computed tomography fusion imaging (18F-FDG PET/CT) is an important diagnostic tool in breast cancer. The utility of maximum standardized uptake values (SUVmax) of primary tumors has been evaluated to predict sentinel node (SN) and non-SN metastasis in clinically node-negative (cN0) patients. Patients and Methods 18F-FDG PET/CT was performed on 414 cN0 patients. The following parameters were evaluated: SUVmax at 60 min (SUVmax1), SUVmax at 120 min (SUVmax2), percent change between SUVmax1 and SUVmax2 (ΔSUVmax%), SN metastasis foci maximum size (SN meta size), and ratio of metastatic SNs to total SNs or SN ratio (SNR). It was assessed whether these were risk factors for SN metastasis. The relationship between these parameters and the status of SN and/or non-SN metastasis was retrospectively explored to predict non-SN metastasis. Results All SUV parameters significantly correlated with pathological T factor (pT), nuclear grade, lymphatic invasion (Ly), and Ki-67 labeling index. On multivariate analysis, pT and Ly were independent predictive factors for SN metastasis. In SN meta-positive cases, SN meta size, SNR, and ΔSUVmax% were predictors for non-SN metastasis on univariate analyses, and the former two were independent predictors on multivariate analysis. The combination of SUVmax2 and ΔSUVmax% was an independent predictor of non-SN metastasis (P = 0.0312) and was associated with prediction of non-SN metastasis negative status with high probability (92.3%). Conclusions In patients with cN0 breast cancer, SUV parameters of the primary tumor were correlated with pathological features. The combination of SUVmax2 and ΔSUVmax% may be useful for predicting non-SN metastasis. Electronic supplementary material The online version of this article (10.1245/s10434-020-08269-0) contains supplementary material, which is available to authorized users.

Background To evaluate the clinicopathological and prognostic significance of the percentage change between maximum standardized uptake value (SUVmax) at 60 min (SUVmax1) and SUVmax at 120 min (SUVmax2) (ΔSUVmax%) using dual time point 18F-fluorodeoxyglucose emission tomography/computed tomography (18F-FDG PET/CT) in breast cancer. Methods Four hundred and sixty-four patients with primary breast cancer underwent 18F-FDG PET/CT for preoperative staging. ΔSUVmax% was defined as (SUVmax2 − SUVmax1) / SUVmax1 × 100. We explored the optimal cutoff value of SUVmax parameters (SUVmax1 and ΔSUVmax%) referring to the event of relapse by using receiver operator characteristic curves. The clinicopathological and prognostic significances of the SUVmax1 and ΔSUVmax% were analyzed by Cox’s univariate and multivariate analyses. Results The optimal cutoff values of SUVmax1 and ΔSUVmax% were 3.4 and 12.5, respectively. Relapse-free survival (RFS) curves were significantly different between high and low SUVmax1 groups (P = 0.0003) and also between high and low ΔSUVmax% groups (P = 0.0151). In Cox multivariate analysis for RFS, SUVmax1 was an independent prognostic factor (P = 0.0267) but ΔSUVmax% was not (P = 0.152). There was a weak correlation between SUVmax1 and ΔSUVmax% (P

Background Polymethyl methacrylate (PMMA) membranes have the unique property of adsorption, which can remove medium- and large-weight molecular substances that cannot be removed by normal hemodialysis and hemodiafiltration. Filtryzer® NF (NF) is a newly developed PMMA membrane that suppresses platelet adhesion on the membrane surface and retains an adsorption property. NF is expected to improve inflammatory conditions and clinical symptoms in hemodialysis patients compared with conventional PMMA membranes. Methods Thirty-seven maintenance hemodialysis patients treated with polysulfone (PS) membranes and who had detectable chronic inflammation were enrolled into the study. The patients were randomly allocated into the NF and PS groups and observed for 1 year. C-reactive protein (CRP) values were measured as the primary endpoint. Nutrition, blood cell count, and dialysis itchiness were evaluated as secondary endpoints. Results Significant differences in CRP values were not found between the NF and PS groups. In the PS group, the creatinine generation rate (%CGR) and platelet count, which were included in nutrition and blood cell count, respectively, significantly decreased after 6 and 9 months compared with the start of study, but these parameters did not significantly change in the NF group within 1 year. Dialysis itchiness in the NF group was significantly improved compared with the PS group after 9 months. Conclusions Our results showed that a new PMMA membrane, NF, has a potential to maintain nutritional conditions and the platelet counts and improve dialysis itchiness. Trial registration This study is retrospectively registered with the Clinical Trials Registry of the University Hospital Medical Information Network on February 17, 2015 (registration ID, UMIN000016567).

We report a case of a 70-year-old man with acute acalculous cholecystitis caused by Giardia lamblia. Contrast-enhanced computed tomography (CT) showed distention of the gallbladder due to a pericholecystic abscess without gallstones. Magnetic resonance cholangiopancreatography and drip infusion cholecystocholangiography-CT demonstrated a stricture of the hilar bile duct and cystic duct obstruction. We conducted transpapillary bile duct brush cytology and a biopsy of the hilar bile duct stricture; numerous active trophozoites of Giardia lamblia were observed without malignant findings. We considered this bile duct lesion to be biliary giardiasis. Biliary giardiasis should be taken into consideration when diagnosing acute acalculous cholecystitis.

Purpose To evaluate the quality of our improved multi-kernel chest computed tomography (CT) images. Methods A random sample of 50 normal patients was retrospectively selected from those who underwent chest CT scans between January 2010 and July 2010. Normal lung structures were divided into six categories, and two radiologists independently compared with lung images. Results The improved multi-kernel images were displayed identically to soft tissue images on soft tissue window settings and were evaluated as equal to lung images on lung window settings. Conclusions This improved multi-kernel technique required fewer stored images and simplified examinations of chest CT.

Measurement of radioactive contamination and confirmation of the decontamination effects are important for the recovery from the nuclear accident at the Fukushima Dai-ichi Nuclear Power Plant. We have developed a gamma camera which can visualize the gamma-ray intensity distribution in real time. Experiments were conducted to investigate its performance. An energy resolution of 2.3 % and spatial resolution of 0.68 m at a distance of 5 m were confirmed. In addition, field tests were conducted in the Fukushima Dai-ichi Nuclear Power Plant. The gamma-ray intensity distribution was successfully visualized within as short a time as 10 seconds in an environment with an air dose rate of 1 - 10 mSv/h. Prominent gamma-ray radiation was found from the penetration holes, which connect the inside and outside of the primary containment vessel. From this result, it was found that shielding the penetration holes will improve the work environment during decontamination and cleanup activities. These results indicate the gamma camera will contribute to decontamination work and radiation exposure reduction for workers.

BACKGROUND: The hybrid convolution kernel technique for computed tomography (CT) is known to enable the depiction of an image set using different window settings. OBJECTIVE: Our purpose was to decrease the number of artifacts in the hybrid convolution kernel technique for head CT and to determine whether our improved combined multi-kernel head CT images enabled diagnosis as a substitute for both brain (low-pass kernel-reconstructed) and bone (high-pass kernel-reconstructed) images. METHODS: Forty-four patients with nondisplaced skull fractures were included. Our improved multi-kernel images were generated so that pixels of >100 Hounsfield unit in both brain and bone images were composed of CT values of bone images and other pixels were composed of CT values of brain images. Three radiologists compared the improved multi-kernel images with bone images. RESULTS: The improved multi-kernel images and brain images were identically displayed on the brain window settings. All three radiologists agreed that the improved multi-kernel images on the bone window settings were sufficient for diagnosing skull fractures in all patients. CONCLUSIONS: This improved multi-kernel technique has a simple algorithm and is practical for clinical use. Thus, simplified head CT examinations and fewer images that need to be stored can be expected.

Background Patients with active upper gastrointestinal bleeding (UGIB) require urgent endoscopy, but appropriate criteria for urgent endoscopy in these patients have not yet been established.

Objectives The aim of this study was to noninvasively detect the anti-inflammatory properties of the novel liver X receptor agonist R211945. Background R211945 induces reversal cholesterol transport and modulates inflammation in atherosclerotic plaques. We aimed to characterize with 18F-fluorodeoxyglucose (FDG)–positron emission tomography (PET)/computed tomography (CT) and dynamic contrast-enhanced cardiac magnetic resonance (DCE-CMR) inflammation and neovascularization, respectively, in atherosclerotic plaques with R211945 treatment compared with atorvastatin treatment and a control. Methods Twenty-one atherosclerotic New Zealand white rabbits were divided into 3 groups (control, R211945 [3 mg/kg orally], and atorvastatin [3 mg/kg orally] groups). All groups underwent 18F-FDG–PET/CT and DCE-CMR at baseline and at 1 and 3 months after treatment initiation. Concomitantly, serum metabolic parameters and histology were assessed. For statistical analysis, continuous DCE-CMR and PET/CT outcomes were modeled as linear functions of time by using a linear mixed model, whereas the histological data, animal characteristics data, and nonlinear regression imaging data were analyzed with a 2-tailed Student t test. Results 18F-FDG–PET/CT detected a decrease in mean and maximum standard uptake values (SUV) over time in the R211945 group (both p = 0.001), indicating inflammation regression. The atorvastatin group displayed no significant change (p = 0.371 and p = 0.600, respectively), indicating no progression or regression. The control group demonstrated an increase in SUV (p = 0.01 and p = 0.04, respectively), indicating progression. There was a significant interaction between time and group for mean and maximum SUV (p = 0.0003 and p = 0.0016, respectively) . DCE-CMR detected a trend toward difference (p = 0.06) in the area under the curve in the atorvastatin group, suggesting a decrease in neovascularization. There was no significant interaction between time and group (p = 0.6350 and p = 0.8011, respectively). Macrophage and apolipoprotein B immunoreactivity decreased in the R211945 and atorvastatin groups (p Conclusions Noninvasive imaging with 18F-FDG–PET/CT and DCE-CMR and histological analysis demonstrated significant anti-inflammatory effects of the LXR agonist R211945 compared with atorvastatin. The results suggest a possible role for LXR agonists in the treatment of atherosclerosis.

Objectives We sought to determine the antiatherosclerotic properties of pioglitazone using multimethod noninvasive imaging techniques. Background Inflammation is an essential component of vulnerable or high-risk atheromas. Pioglitazone, a peroxisome proliferator-activated receptor-gamma agonist, possesses potent anti-inflammatory properties. We aimed to quantify noninvasively the anti-inflammatory effects of pioglitazone on atheroma using 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) and dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI). Methods Atherosclerotic plaques were induced in the aorta of 15 New Zealand white rabbits by a combination of a hyperlipidemic diet and 2 balloon endothelial denudations. Nine rabbits continued the same diet, whereas 6 rabbits received pioglitazone (10 mg/kg orally) in addition to the diet. Twelve animals underwent 18F-FDG-PET/CT, and 15 animals underwent DCE-MRI at baseline, 1 month, and 3 months after treatment initiation. Concomitantly, serum metabolic parameters were monitored. After imaging was completed, aortic histologic analysis and correlation analysis were performed. Results The 18F-FDG-PET/CT imaging detected an increase in average standardized uptake value in the control group (p Conclusions Both 18F-FDG-PET/CT and DCE-MRI demonstrate noninvasively the anti-inflammatory effects of pioglitazone on atheroma. Both imaging methods seem suited to monitor inflammation in atherosclerosis.

古来，鍼灸治療は，急症に対して広く応用されてきた。また近年わが国では，現代医学と漢方医学の調和が図られてきた。このような背景の中でわれわれは，結石疝痛発作に対し小野文恵の創案による鍼灸療法（接触鍼法）が奏効した2症例を経験した。第1例は尿管結石疝痛であった。一回の施療により疼痛は緩解し，その後漢方薬の併用にて排石に至った。第2例は総胆管結石の疝痛で食欲不振を伴っていた。同様に一回の施療により疼痛は緩解し食欲も回復したが，血液検査で胆管炎の合併を指摘され，手術となった。今回の症例を通して結石疝痛発作に対する接触鍼療法の有用性とともに，現代医学的評価を並行して施行することの重要性を認識した。現代医学と漢方医学の調和が重要と考えられた。

Diagnosis of adrenal adenomas for patients with primary aldosteronism is sometimes difficult only by referring to the visualization pattern in adrenocortical scintigraphy without regards to standard scintigraphy or suppression scintigraphy with dexamethasone. We studied if quantitative evaluation of the standard scintigraphy without dexamethasone suppression can be useful to diagnose aldosteronomas. Twenty-nine patients who had undergone adrenalectomy with different clinical manifestations (16 patients with primary aldosteronism, 6 patients with Cushing's syndrome and 7 patients without hormonal abnormality) were included in the study. Volume of the adrenocortical adenomas, 131I nor-cholesterol uptake of the adrenocortical adenomas, and 131I nor-cholesterol uptake per unit volume of the adrenocortical adenomas were compared between the 3 groups. The volume of adrenocortical adenomas in the patients with primary aldosteronism was significantly lower than those in the other two groups (Cushing's syndrome p

A precise method for estimating residual radioactivity and decommissioning cost is indispensable when deciding whether to adopt low-activation material. For this precise estimation, accurate estimation of both the thermal neutron flux and the activation cross section of the structural material is necessary. We developed a new groupwise cross-section library that has ten thermal groups for S N transport calculation and activation calculation. These libraries are tested and used for advanced boiling water reactor (ABWR) and advanced pressurized water reactor (APWR) activation analyses.

Screening tests using several reactors were performed to select low-activation raw materials. The number of samples was about 1500. Detailed data were obtained on the concentrations of Co and Eu in low-activation aggregates, low-activation cements, low-activation additives, and low-activation B 4 C sands. After that, we manufactured various types ( 1 / 10 , 1 / 20 , 1 / 30 , 1 / 50 1 / 100 , 1 / 300 ) of low-activation concrete. The term " 1 / 10 low-activation" concrete denotes that the activity reduction rate to ordinary concrete is designed to be 1 / 10 . By admixing with a boron content of ∼1 × 10 21 /cm 3 , the total residual radioactivity reduction rates of low-activation concrete to ordinary concrete, in units of ∑D i /C i (Di: concentration of radionuclide i, Ci: clearance level of radionuclide i citedfrom IAEA-RS-G-1.7), are estimated to range from ∼ 1 / 300 to 1 / 10 000 . It was concluded that most of the shielding concrete around the advanced boiling water reactor (ABWR) or the advanced pressurized water reactor (APWR) are classified below the clearance level of decommissioning by adopting some suitable types of low-activation concrete.

A 40-year-old man, who had been diagnosed with stage 2 pulmonary sarcoidosis, was referred to our hospital for further evaluation of dyspnea and cardiac function. The echocardiogram displayed thinning of the basal interventricular septum (IVS) and a reduced ejection fraction of 21%. Contrast-enhanced cardiac high resolution MRI (3 tesla) showed patchy subepicardial late gadolinium enhancement in the IVS, and anterior and lateral walls. There was no abnormality in the coronary angiography and the cardiac biopsy showed several small and well-defined noncaseating epithelioid granulomas. The granulomas contained multinucleated giant cells and asteroid bodies (a typical finding of sarcoidosis). Late gadolinium enhancement in high resolution MRI provided information on the pathophysiological condition of cardiac sarcoidosis very clearly, because 3 of 5 samples of endomyocardial biopsy from the septal wall of the right ventricle where late gadolinium enhancement was detected had positive findings for cardiac sarcoidosis (very high rate). These findings indicate that high resolution late gadolinium enhanced MRI might be very useful as a guide for endomyocardial biopsy in patients with cardiac sarcoidosis.

閉塞性動脈硬化症による下肢潰瘍は抗血小板療法や抗凝固療法などの保存的治療に抵抗性の場合，下肢切断術が必要とされる重症の虚血病変である。今回，我々は自家製桂枝茯苓丸と大柴胡湯を投与し，閉塞性動脈硬化症による間欠性跛行と下肢潰瘍が改善した73歳男性の症例を経験したので報告する。この症例の経験により閉塞性動脈硬化症による虚血性病変に対し，西洋医学的な抗凝固療法，抗血小板療法に，桂枝茯苓丸や大柴胡湯を併用することで微小循環改善作用が加わり，虚血病変を安全に少ない負担で改善できる可能性があることが示唆された。

線維筋痛症による全身の疼痛に対し，白虎湯加味方が有効であった症例を経験した。症例は65歳女性。自覚症状として，夏場に，あるいは入浴などで身体が温まると増悪する全身の疼痛および口渇，多飲があり，身熱の甚だしい状態と考えて，白虎湯加味方を使用したところ全身の疼痛が消失した。線維筋痛症に対する漢方治療は，附子剤や柴胡剤が処方される症例が多いが，温熱刺激により全身の疼痛が悪化する症例には白虎湯類が有効である可能性が示唆された。

【目的】和漢診療による病院での入院加療開始時の煎じ薬を含む漢方薬処方の問題点を明らかにするため，当院の薬剤師と和漢診療科病棟担当看護師にアンケート調査を行った。【方法】薬剤師に対しては漢方薬の取扱，調剤時リスクおよび服薬指導に関して，看護師には西洋薬と比較し，配薬時の取扱リスクについて質問した。【結果】アンケートは漢方薬担当薬剤師7名全員，病棟看護師16名中14名が回答した。薬剤師は調剤に手間がかかる点を指摘したが，西洋薬に比較して調剤リスクはないと回答した。服薬指導経験者は1名のみであった。看護師は煎じ薬のみ，やや扱いにくいと考えていたがリスクは同じと考えていた。【総括】薬剤師と看護師ともに煎じ薬について，やや取り扱いにくいがリスク・管理での問題は少ないと考えていた。入院治療の開始までの医師，薬剤師，看護師，事務部門との十分な打ち合わせと教育が重要と考えられた。

控訴人（第一審被告）、被控訴人（第一審原告）間の高松高等裁判所・平成二○年（行三第二号・裁決取消請求控訴事件について、控訴人から、自治体の新設合併に伴う職員の身分変動と不利益処分該当性について、意見を求められたので、次のとおり意見を述べるものである。

十全大補湯が有効であった皮膚疾患3例を経験した。十全大補湯は伝統的に気血両虚の病態に使用され，現在では様々な皮膚疾患にもしばしば応用されている方剤である。自然免疫系の受容体であるToll‐like receptors （TLRs）が抗原提示細胞に発現していることが近年明らかになっているが，我々は以前，十全大補湯がマウス腹腔滲出細胞において，TLR4シグナル伝達経路に影響を及ぼし，interleukin‐12（IL‐12）およびinterferon‐γ（IFN‐γ）産生を増強することを報告した。表皮にも抗原提示細胞であるLangerhans細胞が存在するため，十全大補湯がLangerhans細胞のTLRシグナル伝達経路に作用しTh1／2バランスを改善している可能性がある。皮膚疾患に対する十全大補湯の作用機序の一つとして，自然免疫系を介する獲得免疫系への影響を示唆する症例と考えられた。

慢性骨髄性白血病の治療においては，BCR／ABLチロシンキナーゼ阻害剤であるメシル酸イマチニブが第一選択薬として用いられている。同剤の副作用として，血液毒性，肝障害，浮腫・体液貯留，消化器症状，皮膚症状などが知られている。今回，副作用の一つである下痢に対し，半夏瀉心湯が有効であった症例を経験した。症例は61歳女性。2004年4月，慢性骨髄性白血病と診断。メシル酸イマチニブによる治療により同年10月には寛解し，その後，メシル酸イマチニブ400mgを服用していた。治療開始後，1日4－5回の下痢が続いているため，2005年6月当科初診。半夏瀉心湯服用により4週間後には，1日2回の軟便となり，8週間後には普通便となった。メシル酸イマチニブは，慢性骨髄性白血病寛解維持のために継続的に服用することが望ましいとされている薬剤である。漢方薬を併用することで治療が継続可能となったことは，東西医学の融合という観点からも意義深いと考えられる。

To determine whether thallium-201 ((201)Tl) brain single photon emission computed tomography (SPECT) could supplement magnetic resonance (MR) imaging diagnostic information by visual comparison of two separate data sets from patients with ring-like contrast-enhanced cerebral lesions.A combination of MR imaging and (201)Tl brain SPECT sets obtained from 13 patients (10 men, 3 women) ranging in age from 26 years to 86 years (mean 61.0 years) were retrospectively reviewed. A total of 12 patients had a solitary lesion, and the others had multiple lesions. All but two intracranial foci were pathologically confirmed. The final diagnoses were six glioblastomas, two cerebral metastases from lung cancer, and one each of abscess, resolving hematoma, primary central nervous system lymphoma, toxoplasmosis, and radiation necrosis. The two separate image formats (MR images and SPECT) were shown to ten readers with practical experience. All of the MR images for each patient were shown to each reader first. After interpreting them, the readers were shown the SPECT images. Images were scored in terms of how benign or malignant the foci were on a 5-point scale from "definitely benign" to "definitely malignant."The improvement in the performance of all ten readers was from 67.7% to 93.8% in mean accuracy (P = 0.0028) and from 0.730 to 0.971 in mean Az value (P = 0.0069) after they were shown the (201)Tl brain SPECT images.(201)Tl brain SPECT should substantially increase confidence in the diagnosis of intracranial lesions with ring-like contrast enhancement when MR imaging does not permit differentiation between benign and malignant disease.

We have investigated the inhibitory effect of trans-cinnamaldehyde (CA), one of the principal constituents of essential oil derived from Cinnamomi cortex, on the growth of influenza A/PR/8 virus in vitro and in vivo. When 1-h drug treatment was initiated at various times post-infection (p.i.) in Madin-Darby canine kidney cells using a fixed dose of CA (40 microM), the maximum inhibitory effect (29.7% virus yield of control) was obtained when drug treatment was started at 3h p.i. Under the same treatment schedule, CA inhibited the virus growth in a dose-dependent manner (20-200 microM), and, at 200 microM, the virus yield was reduced to an undetectable level. RT-PCR and SDS-PAGE analyses showed that CA inhibited viral protein synthesis at the post-transcriptional level. In mice infected with the lung-adapted PR-8 virus, inhalation (50mg/cage/day) and nasal inoculation (250 microg/mouse/day) of CA significantly increased survival rates on the 8 days to 100% and 70%, respectively, in contrast to a survival rate of 20% in the untreated control group. Importantly, inhalation of CA caused virus yield reduction by 1 log in bronchoalveolar lavage fluid on day 6 after infection, compared with that of the untreated control group. These findings might provide further support to the empirical indication of Cinnamomi cortex-containing Kampo medicines for acute respiratory infectious diseases.

抑肝散加陳皮半夏は神経過敏, 易興奮, 易怒性, 不安・不眠などの精神神経症状を目標に用いられてきた。我々は心下悸, 臍上悸, 臍下悸を顕著に認める腹証から慢性頭痛の6症例 (緊張型頭痛1例, 片頭痛2例, 緊張型頭痛と片頭痛の混合型3例) に予防療法として抑肝散加陳皮半夏を投与し有効であった。今回の検討から抑肝散加陳皮半夏は緊張型頭痛のみならず片頭痛や混合型頭痛に対しても有効である可能性が示唆された。

半夏厚朴湯は『金匱要略』を原典とする処方で咽中炙臠を主要な目標として胃症状, 神経症状, 咽喉付近の症状あるいは浮腫を表すものに応用されてきた。今回, 我々は肩甲間部の疼痛・凝りなどの違和感を訴える2症例に半夏厚朴湯エキスを投与し奏効した。この経験を基に気鬱・水毒の症候, 肩甲間部違和感を有し, 咽中炙臠を伴わない15症例に半夏厚朴湯を投与し検討を行った。その結果, 全ての症例において愁訴の軽減とともに肩甲間部の違和感も軽減あるいは消失を認めた。このことから咽中炙臠を伴わない症例であっても胃部の停滞感, 腹部膨満感, 胃内停水, ガスの滞留といった従来用いられている目標に加えて肩甲間部, 特に第4～7胸椎棘突起両傍の違和感や圧痛の有無を証明することで, さらに本方の応用範囲が広がりうるものと考えられる。