Objective: The present study aimed to investigate the identification codes of tablets used in clinical practice, and to clarify the influence of these codes on the differentiation of drugs brought in by patients, and those that have been dispensed as one-dose packages at Tottori University Hospital.
Methods: We obtained the identification codes of tablets, which were released on the market before December 2013, based on their package inserts.  Concerning drugs without identification codes, we conducted a questionnaire survey involving companies releasing these drugs in order to clarify the reasons for the absence of these codes.  Among the drugs brought to the Hospital by patients who were hospitalized in 2013, we investigated the identification codes of tablets dispensed as one-dose packages, and the accuracy of the differentiation of these tablets.
Results: We investigated a total of 5,797 tablets. Among the tablets in which the identification codes imprinted on one side of these tablets were the same, the other side did not have codes for 65 tablets (28 pairs), and had different codes for 1,836 tablets (198 pairs).  A total of 244 tablets did not have identification codes.  The most common reason for releasing drugs without such codes was the cost.  Investigation of the drugs brought in by patients hospitalized revealed that some pharmacists mistook Grinolart®50 mg for Glucobay®50 mg due to them having the same code.
Conclusion: To prevent the misidentification of drugs brought in by patients, hospital pharmacists need to cooperate with other hospitals and health insurance pharmacies, and dispense drugs while regarding their distinguishability as of major importance.  In addition, to increase the distinguishability, identification codes need to be imprinted on both sides of tablets, and there is a need to avoid manufacturing drugs whose identification codes are the same.

Introduction: In this study, we examined the behaviors by clinical therapists necessary for shared decision-making (SDM) in the rehabilitation area.Methods: Five physical and occupational therapists participated in a focus group interview conducted using semi-structured interview protocols. The interview questions were: i) what skills do therapists need to involve patients in clinical decisions; ii) what would constitute a successful shared decision between a patient and a therapist; iii) what stages could be identified and observed in clinical decisions; and iv) are there any other elements necessary for SDM. From transcripts of the recorded interviews, qualitative thematic analysis was used to extract the behaviors in clinical therapists necessary for SDM in the rehabilitation area.Results: As a result of the analysis, 16 elements were extracted as behaviors by clinical therapists necessary for SDM in the rehabilitation area. The extracted elements were classified into two categories: providing information to patients (disorder, patient's role, options, purpose of rehabilitation, incorporation of patient opinion, and satisfactory explanation) and gathering information from patients (knowledge, preference, expectation, way of life, hope, understanding, question, opinion on recommendation, disagreement, mutual agreement).Conclusion: In this study, the elements based on the decision-making situation in the rehabilitation area were extracted from the behaviors by clinical therapists necessary for SDM.

  We reviewed the clinical features and treatment outcome of 110 children with leukemia. Treatment was performed between 1980 and 2009 at our hospital. The mean age at onest was 5 years 6 months, the ratio of males to females was 1:0.72, and mean leukocyte count was 4.91×10⁴/μl. Subtypes of leukemia were acute lymphoblastic leukemia (ALL) in 79.1% of the patients, acute myeloid leukemia (AML) in 17.2%, and chronic leukemia in 3.6%. In all patients, the overall 30-year survival rate estimated by the Kaplan-Meier method was 67.4%. In the three decades from the 1980s, the overall 10-year survival rate has been improved significantly from 46.4% in the 1980s, 69.2% in the 1990s to 87.2% in the 2000s (P<0.01). The overall 10-year survival rate was 70.7% in all children with ALL, and 70.6% in all children with AML. But in the last decade, the 10-year survival rate was improved to 87.0% in children with ALL and 87.3% in children with AML. Twenty-four patients received hematopoietic stem-cell transplantation, and the 10-year survival rate was 58.6% after transplant. Second malignancies were detected in three patients, and six patients have long-term sequelae. In conclusionn, the treatment result of childhood leukemia has improved considerably, so that more intensive treatment for patients with poor prognosis and less toxic treatment for patients with good prognosis will be necessary in future.

BACKGROUND: Ballooned hepatocytes (BH) are a key histological hallmark of nonalcoholic steatohepatitis (NASH), yet their consequences for liver-specific functions are unknown. METHODS: In our previous study, an experimental model of human induced-BHs (iBH) has been successfully developed based on cell sheet technology. This study aimed to determine the functions of iBHs in the primary human hepatocyte/ normal human dermal fibroblast (PHH/NHDF) co-culture cell sheets. Normal hepatocytes in the PHH/3T3-J2 co-culture cell sheets were set as a control, since 3T3-J2 murine embryonic fibroblasts have exhibited previously long term maintenance of PHH functions. RESULTS: It was found that, albumin secretion was not affected in iBHs, but urea synthesis as well as cytochrome P450 enzyme (CYP) activities including CYP1A2 and CYP3A4, were significantly reduced in iBHs. Besides, loss of bile canaliculi was observed in iBHs. These findings are consistent with clinical studies of human NASH. In addition, PHH/ NHDF cell sheets demonstrated two fold higher TGF-b1 secretion compared with PHH/3T3-J2 cell sheets. Furthermore, treatment with a TGF-b inhibitor and a semi-synthetic bile acid analogue (obeticholic acid, phase 3 trial of NASH therapy) ameliorated the histological appearance of established iBHs. CONCLUSION In summary, this study demonstrates the priority of iBHs in recapitulating not only histology but also clinically relevant hepatic dysfunctions in human NASH and suggests TGF-b and bile acid related signal pathway may play important roles in the formation of iBHs.

BACKGROUND: Ballooned hepatocytes (BH) are a key histological hallmark of nonalcoholic steatohepatitis (NASH), yet their consequences for liver-specific functions are unknown. METHODS: In our previous study, an experimental model of human induced-BHs (iBH) has been successfully developed based on cell sheet technology. This study aimed to determine the functions of iBHs in the primary human hepatocyte/ normal human dermal fibroblast (PHH/NHDF) co-culture cell sheets. Normal hepatocytes in the PHH/3T3-J2 co-culture cell sheets were set as a control, since 3T3-J2 murine embryonic fibroblasts have exhibited previously long term maintenance of PHH functions. RESULTS: It was found that, albumin secretion was not affected in iBHs, but urea synthesis as well as cytochrome P450 enzyme (CYP) activities including CYP1A2 and CYP3A4, were significantly reduced in iBHs. Besides, loss of bile canaliculi was observed in iBHs. These findings are consistent with clinical studies of human NASH. In addition, PHH/ NHDF cell sheets demonstrated two fold higher TGF-b1 secretion compared with PHH/3T3-J2 cell sheets. Furthermore, treatment with a TGF-b inhibitor and a semi-synthetic bile acid analogue (obeticholic acid, phase 3 trial of NASH therapy) ameliorated the histological appearance of established iBHs. CONCLUSION In summary, this study demonstrates the priority of iBHs in recapitulating not only histology but also clinically relevant hepatic dysfunctions in human NASH and suggests TGF-b and bile acid related signal pathway may play important roles in the formation of iBHs.

Purpose: Quantitative elastography methods, such as ultrasound two-dimensional shear-wave elastography (2D-SWE) and magnetic resonance elastography (MRE), are used to diagnose liver fibrosis. The present study compared liver stiffness determined by 2D-SWE and MRE within individuals and analyzed the degree of agreement between the two techniques. Methods: In total, 888 patients who underwent 2D-SWE and MRE were analyzed. Bland-Altman analysis was performed after both types of measurements were log-transformed to a normal distribution and converted to a common set of units using linear regression analysis for differing scales. The expected limit of agreement (LoA) was defined as the square root of the sum of the squares of 2D-SWE and MRE precision. The percentage difference was expressed as (2D-SWEMRE)/ mean of the two methods×100. Results: A Bland-Altman plot showed that the bias and upper and lower LoAs (ULoA and LLoA) were 0.0002 (95% confidence interval [CI], -0.0057 to 0.0061), 0.1747 (95% CI, 0.1646 to 0.1847), and -0.1743 (95% CI, -0.1843 to -0.1642), respectively. In terms of percentage difference, the mean, ULoA, and LLoA were -0.5944%, 19.8950%, and -21.0838%, respectively. The calculated expected LoA was 17.1178% (95% CI, 16.6353% to 17.6002%), and 789 of 888 patients (88.9%) had a percentage difference within the expected LoA. The intraclass correlation coefficient of the two methods indicated an almost perfect correlation (0.8231; 95% CI, 0.8006 to 0.8432; P<0.001). Conclusion Bland-Altman analysis demonstrated that 2D-SWE and MRE were interchangeable within a clinically acceptable range.

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.

Context: Delirium in cancer is often difficult to control and refractory when haloperidol is invalid which is considered standard therapy. We need second and subsequent-line therapy to reduce hyperactivity and not to over-sedation for refractory delirium. Objectives: To investigate the efficacy and safety of continuous subcutaneous infusion chlorpromazine on delirium refractory to first-line antipsychiatric medications in advanced cancer palliative care setting. Method: The study population consisted of patients who received continuous subcutaneous infusion chlorpromazine for delirium at two certified PCU. Primary endpoint was the proportion of patients who showed improvements in delirium severity by Delirium Rating Scale Revised 98 score of less than 13 or decrease from baseline and maintained the ability to communicate coherently by Communication Capacity Scale Item-4 score of 2 or less. Secondary outcome were the Nursing Delirium Screening Scale subscale score, and injection site reactions evaluated according to the Common Terminology Criteria for Adverse Events. These outcome measures were assessed at baseline, 48 hours and 7 days after the start of the study. Result: Among eighty-four patients, sixty were positive responders (71.4%, 95% CI [61–80]). The mean CCS Item-4 scores significantly decreased from the baseline value of 1.48 (range 0–3) to 1.03 (range 0–3) at post-treatment (p<0.001). Grade 2 or higher injection site reactions were observed in 1 patient (1.2%, 95% CI [0–7]). Conclusion: Our study suggested that continuous subcutaneous infusion chlorpromazine could improve refractory delirium symptoms and patients’ communication capabilities. Although most of the skin disorders observed in association with chlorpromazine were mild, their incidence rates were relatively high, suggesting the need for careful monitoring.