The practical use of abdominal examination is a major characteristic of Kampo medicine. Although most Kampo medical texts describe an abdominal examination for a Kampo formula, comparative studies between texts have not contributed to any standardized descriptions for such examinations. We investigated descriptions of 147 prescription Kampo extract formulations in Kampo texts written after the Showa Era, and obtained the following results. Abdominal examinations were described differently by authors, even for the same prescription. Additionally, we examined the descriptions for anchusan (安中散) and kososan (香蘇散), which are called the Gosei school formulae (後世方). Descriptions of abdominal examinations for these drugs were not quoted from an original Chinese medical text, but were empirically constituted in Japan. As knowledge was accumulated, these various descriptions were created through limited personal connections, and/or the opinions of particular authorities. We suggest that a consensus on abdominal examinations would further studies on the viability of traditional medicines, and better characterize Kampo medicine.

Background: Although several dexamethasone phosphate preparations are commercially available and frequently administered with octreotide acetate, their compatibility remains unknown. Aim: We investigated the effect of pH and sodium bisulphate on the stability of octreotide acetate. Measurement design: Octreotide acetate percentage was measured 3 and 10 days after it was mixed with 2 dexamethasone phosphate preparations containing different concentrations of sodium bisulphate as an additive, and in one that did not contain sodium bisulphate. Solutions were also analysed after they were prepared using phosphate buffer to achieve pH values of 4.0, 7.0, and 9.0. The initial octreotide acetate concentration was 41.7 g/mL. High-performance liquid chromatography was used for measurement. Results: The octreotide acetate percentage in the mixture with dexamethasone phosphate without sodium bisulphate was maintained at 95% for up to 10 days. However, mixing octreotide acetate with the other 2 agents resulted in a significant decrease to 85%. The octreotide acetate percentage was ＜90% after sodium bisulphate-containing solution was stored at room temperature under light-protected conditions for 3 days. The percentage of octreotide acetate in the pH 7.0 solution was ＜90% three days after preparation; however, in the pH 4.0 solution, it was maintained at 95% for up to 10 days. Conclusions: Our results suggest that octreotide acetate is hydrolysed in the presence of sodium bisulphate, leading to a decrease in the percentage of octreotide acetate in the solution, which can be avoided using sodium bisulphate-free dexamethasone phosphate preparations.

The importance of off the job training in surgical education are widely recognized. The Japanese Board of Cardiovascular Surgery has required a board candidate to do at least 30 hours of off the job training from 2017. U-40 Basic Lecture Course are held annually for young cardiovascular surgeon to learn about basic surgical skills. U-40 Advanced Lecture Course was started to provide opportunity to have more advanced hands-on lecture for young cardiovascular surgeon. However, after the COVID-19 pandemic, the opportunity to hold hands-on seminars are highly limited. In such circumstances, we held a hybrid hands-on seminar. We report details about the hybrid hands-on seminar.

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.

Purpose: This study aimed to investigate the current status and related factors of End of Life discussions between heart failure patients and medical professionals. Method: We conducted a survey of medical records of patients who died between April 2015 and March 2020 in the Department of Cardiology, Kyoto University Hospital. We examined the presence or absence of discussions about prognosis and end-of-life care and their associated factors. Result: Of the 109 patients, prognosis was explained to 40 (36.7%) and discussion of end-of-life care was provided to 25 (22.9%). Age (younger), number of hospitalizations, palliative care team intervention, and end-of-life care discussions were associated with the prognostic explanations. Gender (male), number of hospitalizations, history of heart failure hospitalization, palliative care team intervention, and prognosis explanation were associated with the end-of-life care discussions. Conclusion: The study suggested that End of Life discussions in heart failure patients are currently focused on patients with severe and end-stage heart failure.