Oxycodone controlled-release (CR) tablets are used as a first-line opioid analgesic for cancer pain. However, use of oxycodone CR tablets is associated with toxicities such as drowsiness and constipation, leading to deterioration of the quality of life (QOL), especially in patients with gynecologic cancer. In contrast, fentanyl has a superior toxicity profile while still showing a strong analgesic effect. Although fentanyl has been approved for switching from opioid, there have been no Japanese studies of patients with gynecologic cancer who were switched to transdermal fentanyl after experiencing toxicity during therapy with oxycodone CR. More importantly early introduction of palliative therapy for pain has not been adopted routinely in the management of gynecologic cancer. Thus, it appears that treatment for patients with gynecologic cancer remains unsatisfactory at present. We conducted research into improvement of the toxicity profile and pain control with the aim of improving QOL for patients with gynecologic cancer. We showed that pain, drowsiness, and constipation could be significantly improved in gynecologic cancer patients as a result of switching to transdermal fentanyl therapy at an early stage.

Depression and pain are common and often early non-motor symptoms of Parkinson disease (PD). The relationship between pain and depression in PD has been unsettled, with conflicting findings. The PD patients followed up at the general neurology outpatient clinics were requested to complete Beck Depression Inventory (BDI) and McGill pain questionnaire. The patients were categorized in three groups according to the Hoehn-Yahr (H-Y) stage of PD; mild (stage I&II), moderate (stage III) and advanced stage (stage IV&V), and group comparisons were performed in each group between those with and without pain. A total of 186 patients completed the questionnaires. Their mean age was 74±9.3 years, and the mean H-Y stage was 2.8±0.8.Sixty-nine percent of the patients reported pain symptoms of various natures. The BDI scores were significantly higher in the pain group (P< 0.0001) despite the absence of statistically significant differences in the mean age, H-Y stage, and duration of illness. Only PD patients of mild stage revealed significant difference of BDI scores between those with pain and without pain (P <0.001). Our results showed that pain is a common symptom in patients with PD and suggest that it may be related to depression in the early stage of the disease.

Depression and pain are common and often early non-motor symptoms of Parkinson disease (PD). The relationship between pain and depression in PD has been unsettled, with conflicting findings. The PD patients followed up at the general neurology outpatient clinics were requested to complete Beck Depression Inventory (BDI) and McGill pain questionnaire. The patients were categorized in three groups according to the Hoehn-Yahr (H-Y) stage of PD; mild (stage I&II), moderate (stage III) and advanced stage (stage IV&V), and group comparisons were performed in each group between those with and without pain. A total of 186 patients completed the questionnaires. Their mean age was 74±9.3 years, and the mean H-Y stage was 2.8±0.8.Sixty-nine percent of the patients reported pain symptoms of various natures. The BDI scores were significantly higher in the pain group (P< 0.0001) despite the absence of statistically significant differences in the mean age, H-Y stage, and duration of illness. Only PD patients of mild stage revealed significant difference of BDI scores between those with pain and without pain (P <0.001). Our results showed that pain is a common symptom in patients with PD and suggest that it may be related to depression in the early stage of the disease.
Parkinson Disease

Purpose: Total or proximal gastrectomy of the upper-third early gastric cancer (u-EGC) often causes severe post-gastrectomy syndrome, suggesting that these procedures are extremely invasive for patients without pathologically positive lymph node (LN) metastasis. This study aimed to evaluate the clinical applicability of a stomach function-preserving surgery, local resection (LR), with prophylactic left gastric artery (LGA)-basin dissection (LGA-BD). Materials and Methods: The data of patients with u-EGC (pathologically diagnosed as T1) were retrospectively analyzed. Total gastrectomy was performed in 30 patients, proximal gastrectomy in 45, and subtotal gastrectomy in 6; the LN status was evaluated assuming that the patients had already underwent LR + LGA-BD. This procedure was considered feasible in patients without LN metastases or in patients with cancer in the LGA basin. The reproducibility of the results was also evaluated using an external validation dataset. Results: Of the 82 eligible patients, 79 (96.3%) were cured after undergoing LR + LGA-BD, 74 (90.2%) were pathologically negative for LN metastases, and 5 (6.1%) had LN metastases, but these findings were only observed in the LGA basin. Similarly, of the 406 eligible tumors in the validation dataset, 396 (97.5%) were potentially curative. Tumors in the lesser curvature, post-endoscopic resection status, and small tumors (<20 mm) were considered to be stronger indicators of LR + LGA-BD as all subpopulation cases met our feasibility criteria. Conclusions More than 95% of the patients with u-EGC might be eligible for LR + LGA-BD.This function-preserving procedure may contribute to the development of u-EGC without pathological LN metastases, especially for tumors located at the lesser curvature.

Drug dispensing is a statutory and designated duty of a pharmacist. We aimed to examine the changes in the nature of drug dispensing using a text mining method. Our corpus consisted of text documents from “Chozai Shishin”, the most standard manual for dispensing drugs in Japan, Editions 1 to 13 (Japan Pharmaceutical Association), and we used the KH Coder software for text mining. We constructed networks showing the association between frequent word co-occurrence and edition number, and co-occurrence relations for frequent words in each edition. We found that “patient” superseded “dispensing” as a frequent term over time. “Dispensing” was another frequent term with a highly centralized node in each edition. Accordingly, we targeted the term “dispensing” for network analysis to depict its co-occurrence relations. We found that the range of related words for “dispensing” broadened from “preparation” and “compounding” to include “patient adherence instructions”, “assessment”, “medical treatment”, and “information provision”. Accordingly, we concluded that the content of “dispensing”, which is a pharmacist’s duty, has expanded from the duties of “dispensing drugs” to include “responding to patients” within the definition of “dispensing”, and we were able to present this finding as objective data by using the mechanical method known as text mining.

Drug dispensing is a statutory and designated duty of a pharmacist. We aimed to examine the changes in the nature of drug dispensing using a text mining method. Our corpus consisted of text documents from “Chozai Shishin”, the most standard manual for dispensing drugs in Japan, Editions 1 to 13 (Japan Pharmaceutical Association), and we used the KH Coder software for text mining. We constructed networks showing the association between frequent word co-occurrence and edition number, and co-occurrence relations for frequent words in each edition. We found that “patient” superseded “dispensing” as a frequent term over time. “Dispensing” was another frequent term with a highly centralized node in each edition. Accordingly, we targeted the term “dispensing” for network analysis to depict its co-occurrence relations. We found that the range of related words for “dispensing” broadened from “preparation” and “compounding” to include “patient adherence instructions”, “assessment”, “medical treatment”, and “information provision”. Accordingly, we concluded that the content of “dispensing”, which is a pharmacist’s duty, has expanded from the duties of “dispensing drugs” to include “responding to patients” within the definition of “dispensing”, and we were able to present this finding as objective data by using the mechanical method known as text mining.