We present the case of a 56-year-old man who had undergone a total debranched TEVAR for a distal arch aneurysm in an other hospital 7 years eariler. One year after the surgery, a graft infection occurred and the left subclavian artery graft was removed and an axillo-axillary bypass was done. However, the infection persisted and two cutaneous fistulae at the left neck and median sternotomy were recognized. Preoperative FDG-PET CT revealed a high uptake of FDG in the left common carotid artery graft, the stent graft in the ascending aorta, and the left neck wound and median sternotomy site. After we exposed the left common carotid artery, the left chest was entered through a posterolateral thoracotomy. The cardiopulmonary bypass was initiated by cannulating the left common femoral vessels and main pulmonary artery, and core cooling was done to 23℃. The descending aorta was clamped at the Th10 level, and the proximal descending aorta to arch was opened to remove the infected stent graft. Selective antegrade cerebral perfusion was started and antegrade cardioplegia was given. The ascending-arch-descending aorta was replaced with a rifampicin-soaked Dacron graft, followed by left common carotid artery reconstruction using an 8 mm Gore-Tex graft. The new graft was wrapped with a pedicled omental flap. Postoperative antibiotic therapy was continued for 6 weeks and the fistulae were surgically closed. The patient was discharged and is back to the normal life.

The Japan Anti-Doping Agency aims to eliminate doping to protect athletes’ health. However, unintentional doping violations can occur when athletes unknowingly consume prohibited substances. As future professionals, student pharmacists are expected to learn about anti-doping measures, while sports science students must learn how to comply with regulations. However, comparative studies on anti-doping awareness among students from different faculties remain limited in Japan. In this study we surveyed students from Nihon University who took Introduction to Anti-doping in the College of Sports Sciences, 2023, and student pharmacists who took the Science of Health and Physical Fitness II course in the School of Pharmacy, 2024. A comparison of the responses for each question of the survey revealed a significant difference in knowledge content regarding medicines. However, there were no apparent differences between the two faculties of participants in terms of awareness of anti-doping measures. Next, using qualitative research by text mining, we also found differences in anti-doping awareness among students of each school. First, the student pharmacists responses consisted of comments like: “Supporting athletes as a pharmacist,” “An interest in becoming a sports pharmacist” and “Consideration for patients who are athletes.” On the other hand, the Sports Science students responses consisted of comments like “Necessary for coaching athletes,” “Attitude toward doping as an athlete” and “Acquisition of knowledge through lectures.” In this study, qualitative analysis using text mining revealed that both the sports science students and pharmacy students constructed faculty-dependent behavioral goals related to anti-doping, demonstrating the usefulness of these courses.

Objective: There is no consensus on whether platinum doublet chemotherapy or lenvatinib and pembrolizumab (LEN/PEM) is superior for advanced or recurrent endometrial cancer. Thus, this study aimed to compare the prognosis and adverse events in patients with advanced or recurrent endometrial cancer treated with platinum doublet chemotherapy or LEN/PEM. Methods: We retrospectively reviewed the medical records of patients who received platinum doublet chemotherapy or LEN/PEM at our institution for advanced or recurrent endometrial cancer and had a history of platinum-based chemotherapy between January 2013 and August 2023. Results: During the study period, 11 regimens were identified in the platinum doublet chemotherapy group, and 11 regimens were identified in the LEN/PEM group. The objective response rates of the platinum doublet chemotherapy and LEN/ PEM groups were 36.4% and 54.5% (P=0.67), respectively. The 6-month progression-free survival (PFS) rates of the platinum doublet chemotherapy and LEN/PEM groups were 27.3% (95% confidence interval [CI], 13.8%-40.7%) and 70.0% (95% CI, 55.5%-84.5%), respectively. The differences were significant between the two groups. Multivariate analyses of histology, prior lines of chemotherapy, platinum-free intervals, and regimens revealed that the LEN/PEM group had significantly better PFS rates. Conclusion Treatment with LEN/PEM resulted in significantly longer PFS than that of treatment with platinum doublet chemotherapy in patients with advanced and recurrent endometrial cancer. However, further large-scale studies are required to validate these findings.

Objective: There is no consensus on whether platinum doublet chemotherapy or lenvatinib and pembrolizumab (LEN/PEM) is superior for advanced or recurrent endometrial cancer. Thus, this study aimed to compare the prognosis and adverse events in patients with advanced or recurrent endometrial cancer treated with platinum doublet chemotherapy or LEN/PEM. Methods: We retrospectively reviewed the medical records of patients who received platinum doublet chemotherapy or LEN/PEM at our institution for advanced or recurrent endometrial cancer and had a history of platinum-based chemotherapy between January 2013 and August 2023. Results: During the study period, 11 regimens were identified in the platinum doublet chemotherapy group, and 11 regimens were identified in the LEN/PEM group. The objective response rates of the platinum doublet chemotherapy and LEN/ PEM groups were 36.4% and 54.5% (P=0.67), respectively. The 6-month progression-free survival (PFS) rates of the platinum doublet chemotherapy and LEN/PEM groups were 27.3% (95% confidence interval [CI], 13.8%-40.7%) and 70.0% (95% CI, 55.5%-84.5%), respectively. The differences were significant between the two groups. Multivariate analyses of histology, prior lines of chemotherapy, platinum-free intervals, and regimens revealed that the LEN/PEM group had significantly better PFS rates. Conclusion Treatment with LEN/PEM resulted in significantly longer PFS than that of treatment with platinum doublet chemotherapy in patients with advanced and recurrent endometrial cancer. However, further large-scale studies are required to validate these findings.

A 25-question “Nationwide Kampo Web Test” was conducted to evaluate the basic knowledge and diagnostic ability of Kampo among medical professionals nationwide. We analyzed the scores of all 608 examinees (241 doctors, 257 pharmacists, 77 others, 12 acupuncturists, 10 nurses, and 11 dentists) and evaluated the test quality. The performance of all examinees was 67.7 ± 16.9 points (mean score ± standard deviation). Among the doctors, the mean score of Kampo medicine specialists (83.8 ± 8.7 points) was significantly higher than that of non-specialists (65.3 ± 16.3 points) (p<0.0001). The performance of doctors who prescribed 20 or more Kampo medicines (78.4 ± 11.5 points) was significantly higher than that of other doctors (p<0.0001). Among the 25 questions, the difficulty levels of 13, 8, and 4 were easy, moderate, and hard (correct answer rates: 70% or more, 40-70%, and less than 40%), respectively. The ability of 13 questions (52%) to distinguish between good and poor performers was extremely high (discrimination index of 0.5 or higher). Collectively, these results supported the good performance of our test, suggesting that it is a highly practical learning achievement evaluation system that could utilize information and communication technology and is expected to be used in future lifelong learning in the field of Kampo medicine.