Purpose: We identified the risk factors for remnant gastric cancer (RGC) based on remnant gastric mucosal characteristics and gastritis morphology in patients undergoing distal gastrectomy. Materials and Methods: This multicenter retrospective study included 100 patients with RGC after distal gastrectomy and 550 patients without RGC treated between 2013 and 2020.Endoscopic findings, including anastomotic redness, red streaks, enlarged folds, bile reflux as anastomotic findings, as well as disappearance of the regular arrangement of collecting venules (RAC), atrophic gastritis, and intestinal metaplasia as background gastric mucosal findings, were evaluated. Disease risk score matching (1:1) was adjusted for baseline characteristics. Logistic regression analysis was used to develop a risk score model to stratify RGC risk into low, moderate, and high categories. Results: After matching, 96 patients with RGC and 96 controls were analyzed. Anastomotic redness and red streaks, as well as the disappearance of RAC and atrophic gastritis, were significantly more frequent in the RGC group than in the control group, whereas enlarged folds and bile reflux showed no significant differences. Risk scores were assigned as follows:anastomotic redness, 2; red streaks, 3; disappearance of RAC, 7; and atrophic gastritis, 3. The total score stratified patients into high (≥15), moderate (7–14), and low risk (≤6). The positive and negative predictive values were 67.7% and 83.3%, respectively. Conclusions The endoscopic findings of anastomotic redness, red streaks, RAC disappearance, and atrophic gastritis were significantly associated with RGC development.The proposed risk-scoring model could serve as a stratification tool for RGC surveillance.

Patients with heart failure often have difficulty in stopping cardiotonic drugs as the disease stage progresses, and long-term hospitalization is a factor that significantly reduces quality of life. To solve this problem, in September 2017, our hospital started an initiative to support overnight stays at home by using a portable precision infusion pump and continuously injecting cardiotonic drugs with the approval of the hospital’s medical ethics committee. Since there are few case reports of similar efforts in Japan, here we describe the use of drugs and the content of the intervention by pharmacists. The drug is administered via a peripherally inserted central venous catheter using an ambulatory precision infusion pump. The pharmacist calculates the drug dose and flow rate required during the at-home period using spreadsheet software, and proposes a prescription to the doctor. In addition, if multiple cardiotonics and diuretics are administered, the presence or absence of compounding changes is confirmed, and the feasibility of mixing should be examined, and then prepared aseptically on a clean bench on the day of administration. We started to administer catecholamine while in the hospital on the day before the stay at home. Then we prepared the catecholamine in a portable precision infusion pump and administered it during stay at home. To date, we have supported 8 cases in stays at home without emergency hospitalization or sudden death due to exacerbation of heart failure.

The aim of this article is to describe the 2017 revised consensus criteria for the clinical diagnosis of dementia with Lewy bodies (DLB) with future directions for the diagnostic criteria. The criteria for the clinical diagnosis of probable and possible DLB were first published as the first consensus report in 1996 and were revised in the third consensus report in 2005. After discussion at the International DLB Conference in Fort Lauderdale, Florida, USA, in 2015, the International DLB Consortium published the fourth consensus report including the revised consensus criteria in 2017. The 2017 revised criteria clearly distinguish between clinical features and diagnostic biomarkers. Significant new information about previously reported aspects of DLB has been incorporated, with increased diagnostic weighting given to rapid eye movement (REM) sleep behavior disorder (RBD) and iodine-123-metaiodobenzylguanidine (MIBG) myocardial scintigraphy. Future directions include the development of the criteria for early diagnosis (prodromal DLB) and the establishment of new biomarkers that directly indicate Lewy-related pathology, including α-synuclein imaging, biopsies of peripheral tissues (skin, etc.) for the demonstration of α-synuclein deposition, and biochemical markers (cerebrospinal fluid/blood), as well as the pathological evaluation of the sensitivity and specificity of the 2017 revised diagnostic criteria. In conclusion, the revised consensus criteria for the clinical diagnosis of DLB were reported with the incorporation of new information about DLB in 2017. Future directions include the development of the criteria for early diagnosis and the establishment of biomarkers directly indicative of Lewy-related pathology.

Objectives : To determine factors related to peoples' preference for visiting home-doctors when experiencing new health problems.
Method : A questionnaire survey was conducted of people receiving annual health checkups in municipalities in the vicinity of Jichi Medical University Hospital. We surveyed personal characteristics, test equipment, having of a home-doctor, and answers to an assumed scenario (asking about willingness to visit a home-doctor in case of getting certain health problems).
According to the responses to the scenario, we divided the subjects into two groups (a home-doctor group: visiting a home-doctor; and a specialist group: not visiting a home-doctor) and statistically compared the two groups.
Results : In the analytic sample of 1,829, the home-doctor group numbered 1,097 individuals (60%) and the specialist group numbered 732 individuals (40%). The home-doctor group statistically had more home-doctors than the specialist group (adjusted odds ratio, 95% confidence interval: 2.47, 2.00-3.05).
More home-doctors in the home-doctor group had test equipment than home-doctors in the specialist group: Gastrointestinal test equipment (gastroscopy, colonoscopy, or ultrasonography) (adjusted odds ratio, 95% confidence interval: 1.39, 1.06-1.83).
Conclusion : We revealed two factors relating to the preference for visiting home-doctors: First, those people had home-doctors, and, second, the home-doctors had test equipment.