Neoadjuvant chemotherapyeoadjuvant chemoradiotherapy (NAC/NACRT) can be performed in patients with pancreatic cancer to improve survival. We aimed to clarify the clinical outcomes of biliary drainage with a metal stent (MS) or a plastic stent (PS) during NAC/NACRT. Between October 2013 and April 2016, 96 patients with pancreatic cancer were registered for NAC/NACRT. Of these, 29 patients who underwent biliary drainage with MS or PS before NAC/NACRT and a subsequent pancreatoduodenectomy were retrospectively analyzed with regard to patient characteristics, preoperative recurrent biliary obstruction rate, NAC/NACRT delay or discontinuation rate, and operative characteristics. The median age of the patients was 67 years. NAC and NACRT were performed in 14 and 15 patients, respectively, and MS and PS were used in 17 and 12 patients, respectively. Recurrent biliary obstruction occurred in 6% and 83% of the patients in the MS and PS groups, respectively (p<0.001). NAC/NACRT delay was observed in 35% and 50% of the patients in the MS and PS groups, respectively (p=0.680). NAC/NACRT discontinuation was observed in 12% and 17% of the patients in the MS and PS groups, respectively (p=1.000). The operative time in the MS group tended to be longer than that in the PS group (625 minutes vs 497 minutes, p=0.051), and the operative blood loss volumes and postoperative adverse event rates were not different between the two groups. MS was better than PS from the viewpoint of preventing recurrent biliary obstruction, although MS was similar to PS with regards to perioperative outcomes.

[PURPOSE] To evaluate the efficacy and safety of acupuncture and moxibustion treatments in breech presentation, we report correction rates and adverse events for correcting breech presentation in our department.[PARTICIPANTS AND METHODS] Subjects were pregnant women who were diagnosed with breech presentation in our obstetrics and gynecology department and started acupuncture and moxibustion treatment between April 1, 2009 and October 31, 2018. The target patients were retrospectively investigated by medical records. The main items investigated were the status of the pregnant women at the time of acupuncture and moxibustion initiation (presence or absence of threatened preterm labor), treatment position (sitting or lateral position), correction rates and occurrence of adverse events. Successful correction was defined as the rate of head position after acupuncture and moxibustion treatments. Adverse events were defined as "unfavorable medical events occurring during or after treatment, regardless of causation."[RESULTS] There were 371 pregnant women in the study; among them 57 women were diagnosed with threatened preterm labor at the start of acupuncture and moxibustion treatment, including 21 pregnant women who were in the hospital. The sitting position was used for treatment for 45.2% (168 cases) of subjects and lateral position was used for 54.7% (203 cases). The correction rates were 72.2% (268/371). In pregnant women with threatened preterm labor who were hospitalized at the time of acupuncture and moxibustion initiation, the correction rates were 28.6% (6/21 cases), which was significantly lower than that of outpatient pregnant women. There was no significant difference in the rate of correction by treatment position between sitting and lateral position. There were no adverse events of vagal reflexes when the left lateral position was treated. The frequency of adverse events per number of procedures was 1.1% (21/1916) and per number of cases was 5.7% (21/371 cases). There were two cases of rupture of membranes with no apparent causal relationship.[CONCLUSION] The safest position for treatment in pregnant women was considered to be the left lateral position. Most of the adverse events were minor or moderate, but there were two cases of rupture of membranes with no apparent causal relationship. When performing acupuncture and moxibustion for breech presentation, it is necessary to work closely with the patient's obstetrician.

[PURPOSE] To examine the safety of acupuncture treatment for breech presentation. [PARTICIPANTS AND METHODS] A retrospective study of cases in which acupuncture in the pelvic position was performed on hospitalized pregnant women with preterm labor in the pelvic position during the period March 1, 20XX-11 to December 28, 20XX was conducted. The survey items included maternal background, maternal and fetal status (including Non stress test), change in drug dosage for preterm labor, outcome of acupuncture treatment, and any adverse events due to acupuncture treatment. [RESULTS] There were 23 pregnant women who qualified for the study. All were receiving standard management of imminent preterm labor. The median number of acupuncture sessions was 7 per patient, for a total of 157 sessions. There was no significant increase in the number of uterine contractions within 24 hours of acupuncture treatment, and in no case was the fetal status assessed as non-reactive before delivery. There was no significant increase in drug dosage within 24 hours of acupuncture treatment. The rate of correction to the cephalic position was 39.1% (9/23 cases). Two adverse events (Grade 1) due to acupuncture treatment were observed, with a frequency of 1.3% (2 cases/157 sessions) per treatment. In addition, there were two cases in which ritodrine hydrochloride was increased within 24 hours of acupuncture treatment.[CONCLUSION] In our study population, there were no signs of fetal distress or worsening of uterine contractions. In the acupuncture treatment methods of our department, the possibility of adverse effects on the mother or fetus was considered low. However, there were two cases in which ritodrine hydrochloride was increased after acupuncture treatment. When providing acupuncture and moxibustion treatment to pregnant women, it is necessary to collaborate with obstetricians.