The number of female physicians is increasing. In Japan, marriage and child–bearing have been considered barriers preventing female physicians from working continuously. This study investigated the effects of marriage and child–bearing on career satisfaction among female physicians.
1)We surveyed the alumni of two private medical schools (University A: n=646; University B: n=316). The response rate was 38% for University A and 71% for University B.
2)When the subjects were asked if they were satisfied that they had chosen a career as a physician, 85%(n=400) answered that they were satisfied.
3)In total, 348 female physicians (74%) were married, and of them, 280 (80%) had experienced childbirth, and 259 (77%) were married to physicians.
4)Factors that significantly and positively affected career satisfaction were marriage for all female physicians and child–bearing for married female physicians.
5)The results of this study suggest that marriage and child–bearing, rather than being obstacles to career development, have positive effects on the career satisfaction of female physicians.

The purpose of this study was to evaluate the effects of highly concentrated enteral nutrition (ENORAS®, Otsuka Pharmaceutical Factory, Tokushima, Japan; hereinafter, ED) on the maintenance of nutritional status and bodyweight in chemotherapy-treated patients with gastrointestinal cancer who received ED between July 2019 and January 2020. For 21 patients (15 men and 6 women, age range: 57-87 years old), we investigated serum albumin level, cholinesterase level, lymphocyte count, hemoglobin level, and bodyweight at baseline and after receiving ED. None of the patients showed any differences in albumin level, cholinesterase level, lymphocyte count, hemoglobin level, or bodyweight before and after receiving ED. Survivors had significantly favorable changes in cholinesterase level compared with non-survivors (p=0.0258). The group that received ED for 30 days or longer tended to show more favorable changes in bodyweight than the group that received ED for less than 30 days (p=0.0696). The group with stage I-III disease had more favorable changes in albumin level than the group with stage IV disease or recurrence (p=0.0932). Our results suggest that the ED is useful for helping to maintain nutritional status and bodyweight in chemotherapy-treated patients with gastrointestinal cancer.

Venous thromboembolism (VTE) is a common complication in patients with cancer, particularly those with gastrointestinal cancers. In addition, patients with distant metastasis of gastrointestinal cancer often require palliative surgery. Here we report on the current status of VTE in patients with gastrointestinal cancers at our hospital, where we treated 20 patients with gastrointestinal cancers who developed VTE between January 2009 and December 2018. Nine patients had gastric cancer, 6 had colorectal cancer, 3 had biliary cancer, and 2 had pancreatic cancer. Fifteen of the 20 patients had distant metastasis as well. Median survival was 9 months, but VTE was not the direct cause of death in any patient. Although many of these patients had advanced cancer with distant metastasis, 16 still required gastrointestinal surgery. Our findings indicate that gastrointestinal surgeons need to be proficient in the diagnosis and treatment of VTE in patients with malignancy.

Pregnancy and childbearing are important issues for female survivors of childhood, adolescent, and young adult (CAYA) cancer. Here, we report the case of a 38-year-old primiparous woman who had been treated with multimodal therapy for ovarian dysgerminoma in childhood. During junior high school, she had been admitted to our hospital complaining of abdominal distension, fever, and dyspnea. A massive abdominal tumor was found, and she was referred to a university hospital for treatment. Ovarian tumors suspected to be ovarian dysgerminoma were diagnosed, and right oophorectomy with lymph node dissection was performed. The left ovary was preserved. Postoperative histologic examination revealed ovarian dysgerminoma with class V ascites cytology, indicating Stage IIIc disease. The postoperative course was uneventful. Following surgery, she received bleomycin, etoposide phosphate, and cisplatin chemotherapy. Menarche occurred 12 years after surgery. She visited a gynecology clinic 24 years and 9 months after surgery because of suspected pregnancy. Pregnancy was confirmed, and she gave birth by vaginal delivery at a gestational age of 35 weeks + 1 day. Both the patient and child are now in good health. Fertility is an important consideration for CAYA cancer survivors. In cases of CAYA cancer, it is important to make treatment decisions together with patients with due consideration given to survival and fertility.

A woman in her 80s was being treated for dementia. She lived in a four-generation household of 8 people. Her grandchild contracted COVID-19 and was admitted in another hospital. The 7 other family members were close contacts of the grandchild, and all of them except the woman with dementia developed COVID-19 within 3 days of onset in the grandchild. The woman’s PCR test for SARS-CoV-2 was negative. Her family thought that she could not live alone, but she was denied admission to other hospitals. Finally, she was admitted to our COVID-19 ward with her other family members at the family's request. After admission, she stayed in a room with family members, and COVID-19 treatment for her family and her care were performed with strict infection control measures in place. On hospital day 11, she and 5 family members had negative PCR test results for SARS-COV-2 and were discharged. With the growing number of dementia patients in Japan's aging society, there is the possibility that similar situations will occur increasingly often. This case suggests that recommended infection control measures are effective for preventing the spread of COVID-19 to people staying in the same room.

Recently, with the increase of laparoscopic surgery, there has also been an increase in the number of surgeries that require the head-down position for a long duration and left-right rotation. We have encountered 3 cases of brachial plexus neuropathy that was thought to be caused by such surgical positions in our institute. Currently, we have improved the fixation method and fixtures and created a neuropathy checklist, and we are conducting standardized observation and decompression programs within the team. We examined whether our current programs are effective using a body pressure measuring device for 20 patients undergoing headdown lithotripsy surgery under general anesthesia. The correlation between the mean body pressure on the right shoulder after 30 min and body tilt angle was studied. We also observed changes in body pressure before and after manual decompression every 30 min while the patient was in the head-down position. Before that study, we conducted an experience questionnaire survey of 10 operating room nurses. The results indicated that there was no increase in body pressure in proportion to the body tilt angle (15-20 deg). The body pressure after decompression decreased significantly at 30, 60, and 120 min after placing the patient in the head-down lithotripsy position. There was no significant correlation between body pressure and the headdown positioning time. There was a significant correlation between body mass index (BMI) and body pressure at 30 min (r=0.474, p=0.035). Complaints of trunk displacement, shoulder pain and pressure, and head and neck traction were often noted in the nurse questionnaire. These complaints were more frequently seen in cases with a larger right-down rotation angle and higher BMI. From these results, it was concluded that decompression of the body with the current fixtures and our regular observation and decompression program using the neuropathy checklist is effective for preventing brachial plexus injury in patients undergoing lithotripsy laparoscopic surgery in the head-down position and with left-right rotation.

Coronavirus disease 2019 (COVID-19) has spread rapidly in Japan. The purpose of this study was to report the clinical experience of our COVID-19 patients early in the pandemic and lessons from our experience. An outpatient fever clinic was established on April 7. Admission of COVID-19 patients was started on July 23. Between April 7 and September 30, there were 364 walk-in outpatients and emergency patients with fever. Polymerase chain reaction test for SARS-CoV-2 RNA or COVID-19 antigen test were performed in all patients, and all results were negative. Twenty patients with COVID-19 were admitted to a newly established dedicated COVID-19 ward. They were discharged well. There were no cases of nosocomial infection at our hospital. Length of hospitalization was correlated with serum ferritin level at admission, serum CRP level at admission, and age. More than half the patients experienced psychological stress, and COVID-19 specialized nurses experienced some stress. It is essential to set up the medical system for COVID-19 according to the trends of the disease. Creation of our original database and our “problem notebook” were useful for treatment and care of COVID-19 patients as well as for mental care of nurses.

BACKGROUND: More than 140 million people drink arsenic-contaminated groundwater. It is unknown how much arsenic exposure is necessary to cause neurological impairment. Here, we evaluate the relationship between neurological impairments and the arsenic concentration in drinking water (ACDW). PARTICIPANTS AND METHODS: A cross-sectional study design was employed. We performed medical examinations of 1867 residents in seven villages in the Thabaung township in Myanmar. Medical examinations consisted of interviews regarding subjective neurological symptoms and objective neurological examinations of sensory disturbances. For subjective neurological symptoms, we ascertained the presence or absence of defects in smell, vision, taste, and hearing; the feeling of weakness; and chronic numbness or pain. For objective sensory disturbances, we examined defects in pain sensation, vibration sensation, and two-point discrimination. We analyzed the relationship between the subjective symptoms, objective sensory disturbances, and ACDW. RESULTS: Residents with ACDW ≥ 10 parts per billion (ppb) had experienced a "feeling of weakness" and "chronic numbness or pain" significantly more often than those with ACDW < 10 ppb. Residents with ACDW ≥ 50 ppb had three types of sensory disturbances significantly more often than those with ACDW < 50 ppb. In children, there was no significant association between symptoms or signs and ACDW. CONCLUSION Subjective symptoms, probably due to peripheral neuropathy, occurred at very low ACDW (around 10 ppb). Objective peripheral nerve disturbances of both small and large fibers occurred at low ACDW (> 50 ppb). These data suggest a threshold for the occurrence of peripheral neuropathy due to arsenic exposure, and indicate that the arsenic concentration in drinking water should be less than 10 ppb to ensure human health.
Adolescent ; Adult ; Arsenic ; analysis ; toxicity ; Cross-Sectional Studies ; Dietary Exposure ; adverse effects ; Dose-Response Relationship, Drug ; Drinking Water ; adverse effects ; chemistry ; Female ; Groundwater ; chemistry ; Humans ; Male ; Middle Aged ; Myanmar ; epidemiology ; Peripheral Nervous System Diseases ; chemically induced ; epidemiology ; physiopathology ; Sensation Disorders ; chemically induced ; epidemiology ; physiopathology ; Water Pollutants, Chemical ; analysis ; toxicity ; Young Adult