The purpose of study was to clarify the factors involved in the popularization of a voluntary group in several locations within Shitara Town. A questionnaire survey was administered to participants of a voluntary group concerning its founding, their participation in the group, and continuity within the group. Responses were obtained from 96 participants. Regarding the founding and participation aspects of the voluntary group, participants believed that the presence of others (i.e., the “existence of peers”) had significant effects. They also believed that voluntary participation that was driven by “one’s own health” was more likely to lead to continued participation. It is important to consider regional factors and interpersonal linkages to enhance the relationship between resident-led self-help and mutual assistance measures aimed at improving residents’ health awareness.

Methods: Five formalin-embalmed human cadavers were used. We assessed the proportion of segmental arteries and veins that intersected the IVD in the L2–L5 range and their course on the anterior part of the spinal column. Results: The segmental arteries and veins commonly intersect the anterior part of the IVD (artery, 28.1%; vein, 42.1%). Seven of 10 (70%) segmental arteries at L2 intersected the IVD, but only one artery intersected the IVD at L3 and L4. The proportions of segmental veins that intersected the IVD were 60%, 50%, and 16.7% at L2, L3, and L4, respectively. Conclusions The segmental arteries and veins frequently intersect the IVD in the anterior part of the spinal column. Therefore, it is necessary to consider these individual anatomical features to prevent vascular damage during lateral lumbar interbody fusion surgery.

Objective:The topic model is a well-known method used in the field of natural language processing (NLP)that defines adocument as constructed of topics that combine specific t erms. This method is used to model topic co-occurrencemathematically. In this study,we extracted topics from featu re vectors of explicit documents called medical package insertsby using cluster analysis. Methods:We counted the terms(nouns)recognized by the morphological analysis engine MeCab and created a documentterm matrix. A value of“tf・idf”was calculated in this matrix for term weighting to avoid the effect of term frequency. We reduced the dimensionality of the matrix using singular v alue decomposition,which removed unnecessary data,and weextracted feature vectors attributed to each medical package insert. The distance between feature vectors was calculatedusing cosine distance,and cluster analysis was performed based on the distance between the vectors.Results:Cluster analysis on our document-term matrix show ed that medical package inserts of drugs that have the sameefficacy or active ingredient were included in the same cl uster. Moreover, using term weighting and dimensionalityreduction,we could extract topics from medical package inserts.Conclusion:We obtained a foothold to apply our findings t o the recommendation of similar drugs. Cluster analysis ofmedical package inserts using NLP can contribute to the pro per application of drugs. In addition,our study revealed thesimilarities of drugs and suggested possibilities for new applications from several points of view.

Methods: HFCs were obtained from patients with LSS who underwent surgery. HFCs were stimulated by tumor necrosis factor-α (TNF-α) and a p38 MAP kinase inhibitor, SB203580. Phosphorylation of the p38 MAP kinase was analyzed by western blotting. The concentration of interleukin-6 (IL-6) in the conditioned medium was measured by enzyme-linked immunoassay and IL-6 messenger RNA expression levels were determined by real-time polymerase chain reaction. Results: TNF-α induced the phosphorylation of p38 MAP kinase in a time-dependent manner, which was suppressed by the p38 MAP kinase inhibitor, SB203580. TNF-α also stimulated IL-6 release in both a time- and dose-dependent manner. On its own, SB203580 did not stimulate IL-6 secretion from HFCs; however, it dramatically suppressed the degree of IL-6 release stimulated by TNF-α from HFCs. Conclusions This is the first report suggesting that TNF-α stimulates the gene expression and protein secretion of IL-6 via p38 MAP kinase in HFCs. A noted association between tissue hypertrophy and inflammation suggests that the p38 MAP kinase inflammatory pathway may be a therapeutic molecular target for LSS.

Methods: HFCs were obtained from patients with LSS who had undergone decompression surgery. The cells were stimulated with TGF-β and pretreated with either the p38 mitogen-activated protein (MAP) kinase inhibitor SB203580 or the p44/42 MAP kinase inhibitor FR180204. IL-6 secretion in the cell culture medium and IL-6 messenger RNA (mRNA) expression levels were analyzed using an enzyme-linked immunoassay and real-time polymerase chain reaction, respectively. Results: TGF-β administration resulted in a dose- and time-dependent stimulation of IL-6 release. Treatment with SB203580 and FR180204 markedly suppressed TGF-β–induced IL-6 secretion from HFCs. Moreover, these inhibitors suppressed IL-6 mRNA expression in response to TGF-β stimulation. Conclusions Our findings indicate that TGF-β induces IL-6 protein secretion and gene expression in HFCs through the activation of p38 or p44/42 MAP kinases. These results suggest a potential association between IL-6–mediated inflammatory response and tissue hypertrophy in LSS, and we provide insights into molecular targets for therapeutic interventions targeting LSS-related inflammation through our analysis of the MAP kinase pathway using HFCs.

A 51-year-old man was referred to our hospital with pain and coldness of the upper left extremity. Contrasted computed tomography revealed a silhouette protruding into the aortic arch. Peripheral embolism in upper left extremity by tumor or thrombosis was suspected. Magnetic resonance imaging revealed a mobile mass in the aortic arch. To prevent recurrent embolization, the mass and the aortic arch to which the mass was attached were excised and partial arch replacement was performed under cardiopulmonary bypass. Histologically, the mass was a fibrin thrombus with no malignancy. The aortic wall showed only mild atherosclerosis of the intima. No thrombotic predisposition such as protein S or C deficiency or antiphospholipid antibody syndrome was observed. Anticoagulant therapy was started and the patient was discharged on postoperative day 10 without recurrent thromboembolism. Three years have passed since the operation and there is no recurrence of thromboembolism.

A 68-year-old man presented with abdominal pain, vomiting, and diarrhea. He was admitted with a provisional diagnosis of acute gastroenteritis based on physical examination, blood tests, ultrasonography, and plain computed tomography. Despite treatment with fasting and fluid replacement, cardiopulmonary arrest occurred the following morning. All attempts at resuscitation failed and the patient died. Pathological autopsy revealed the presence of clots within the superior mesenteric vein, which was diagnosed as superior mesenteric vein thrombosis. This rare disease often manifests with only nonspecific symptoms and is typically difficult to diagnose. Because delayed diagnosis may lead to unfavorable outcomes, it is important to include this disease in the differential diagnosis of abdominal pain.

Objective: The “One-half Rule” for OTC drug sales has been eliminated, and furthermore, “Remote-controlled sales” of OTC medicines by qualified sellers is under discussion. The number of registered sales clerks is greater than the number of pharmacists selling OTC drugs. Although this is a result of the different employment status of pharmacists and registered sales clerks due to their salary structure and role in the store, it can be said that registered sales clerks are the main people to deal with the general public when they purchase OTC drugs. Therefore, we conducted a survey of registered sales clerks in order to understand their actual work and their awareness of the revision of the system, and to estimate the impact on customers and patients.Methods: The questionnaire was administered at an external training session held by the Tokyo Metropolitan Druggist Association from April 16 to 18, 2022.Results: Valid responses were obtained from 319 participants. Responses were obtained for the ratio of work as a registered sales clerk before becoming a qualified, after qualification (present), and what they think would be an ideal work ratio. The percentage of “pharmaceutical consultation and sales” increased from 7.7 to 15.9, and finally 26.4% before, at present, and ideally, respectively. It was clear that the acquisition of the certification increased the percentage of specialized tasks and that the respondents would like to further increase this percentage. Awareness of the “One-half Rule” and “Remote-controlled sales” was 43.6 and 23.8%, respectively.Conclusion: It was inferred that the introduction of “Remote-controlled sales” would improve convenience but dilute interpersonal work, which would hinder the operation, maintenance, and management of the store, including courteous customer service that cannot be handled through a screen. Therefore, from this study, we believe that registered sales clerks express doubt about the introduction of “Remote-controlled sales”.

A 79-year-old woman presented to our hospital with high energy trauma. Enhanced CT revealed injury to the aortic arch. The left carotid artery was pulled out due to extension force and a drawing out lesion formed. Cardiopulmonary bypass was established with cannulation of the right femoral artery and the right atrium, and systemic cooling was started. We opened the aortic arch with deep hypothermic circulatory arrest, and detected a 10 mm drawing out lesion at the bottom of the left carotid artery. Aortic arch was transected at the distal of the left carotid artery to exclude the drawing out lesion, and partial arch replacement was performed. The patient's postoperative course was uneventful, and she was discharged from our hospital without any complication.

In hemodialysis, an adsorbent is used to remove phosphorus from the blood.Because phosphorus adsorbents contain iron, they may cause iron excess, and appropriate management is thus required.In recent years, the use of sucroferric oxyhydroxide (SO), which has become available, is said to be associated with lower iron absorption and is less likely to cause iron excess, as compared with conventional ferric citrate hydrate (FCH). However, in clinical trials of SO conducted in Japan, serum ferritin (Ft) and transferrin saturation (TSAT) tended to increase, and this may cause iron excess similar to FCH. Therefore, we report here on the phosphorus adsorption effect and the influence on iron-related benefit of SO.Among 12 patients, iron-related abnormalities were observed in 3 patients and adverse events such as diarrhea and nausea were observed in 7 patients.In 8 patients who continued taking SO for up to 24 weeks, serum phosphorus (P) decreased, Ft and TSAT increased, Hb, Fe, Ca did not change significantly, and the dose of erythropoiesis-stimulating agents (ESA) decreased. The rate of change of Ft was greater in 5 patients with iron deficiency than in 3 patients with non-ferrous deficiency. SO administration tended to decrease P and improve iron deficiency.In addition, there was a decrease in the dose of ESA, suggesting the possibility of contributing to pharmaceutical cost reduction.Conversely, in patients with iron deficiency, iron-related abnormalities were observed in 3 patients, and about half had adverse events with subjective symptoms 4 weeks after the start of treatment with SO.Therefore, the administration of SO takes into account the effects on iron-related values as well as FCH, it is thus considered important to adjust the dose of SO or ESA depending on the condition while monitoring clinical laboratory values and adverse events from the beginning of administration.