Background Persistent postural-perceptual dizziness (PPPD) is a chronic functional dizziness symptom triggered by psychological stress, but its pathophysiology is unknown. Central sensitization is considered the cause of functional diseases, such as medically unexplained symptoms, and is a psychosocially affected condition. However, the association between dizziness symptoms in PPPD and central sensitization remains unclear. Thus, we conducted a cross-sectional study on the relation between dizziness symptoms and central sensitization in PPPD. Methods We recruited 61 outpatients with dizziness who met the PPPD diagnostic criteria. In addition to the evaluation of dizziness symptoms using the Dizziness Handicap Inventory, the participants were evaluated using the Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, and Central Sensitization Inventory (CSI). A CSI score of 40 or higher was defined as central sensitization syndrome (CSS), and the severity of each condition in CSS and non-CSS participants was compared. We also evaluated the association between dizziness symptoms and central sensitization and coexisting symptoms using linear multiple regression analysis. Results We analyzed the data of 50 valid responses (valid response rate of 82.0 percent). Compared with the non-CSS group, the CSS group had a higher degree of disability owing to dizziness and a higher rate of complications of anxiety and depression. The regression analysis results showed that the severity of central sensitization was a related factor that could enhance the dizziness symptoms of PPPD. Conclusions Central sensitization may affect the dizziness symptoms of PPPD as an exacerbating factor.

Background The change in the benzodiazepine (BZD) use of patients with medically unexplained symptoms (MUS) following the application of relaxation therapy were examined. Methods Of the 221 outpatients with MUS using BZD, 42 received relaxation therapy. Change in BZD use was compared using a relaxation group ( n = 42) and a control group that had 84 MUS patients whose baseline was matched by optimal matching algorithms. Logistic regression analysis was done to evaluate the effect of BZD-dependent factors on the BZD dose of the relaxation group. Results Compared with the control group, the number of patients who decreased the amount of BZD and the number of patients whose subjective symptoms of MUS improved were significantly higher in the relaxation group ( p < 0.05). In addition, a factor that made it difficult to reduce the BZD of MUS patients who had undergone relaxation was a long history of BZD use, for more than 6 months (odds ratio, 0.06, 95% confidence interval, 0.01–0.36). Conclusions Relaxation therapy for patients with MUS may help reduce BZD use; however, early intervention is important to prevent BZD dependence.

The utility of molecular biological analysis in lung adenocarcinoma has been demonstrated. Herein we report a rare case presenting as multiple lung adenocarcinomas with four different EGFR gene mutations detected in three lung tumors. After opacification was detected by routine chest X‐ray, the patient, a 64‐year‐old woman, underwent chest computed tomography which revealed a right lung segment S4 ground‐glass nodule (GGN). Follow‐up computed tomography revealed a 42 mm GGN nodule with a 26 mm nodule (S6) and a 20 mm GGN (S10). Histopathology of resected specimens from the right middle and lower lobes revealed all three nodules were adenocarcinomas. Four EGFR mutations were detected; no three tumors had the same mutations. Molecular biological analysis is a promising tool for the diagnosis of primary tumors in patients with multiple lung carcinomas of the same histotype, enabling appropriate treatment.

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