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.

In this revision, we have attempted to align the Model Core Curriculum for Medical Education competency, "problem-solving ability based on specialized knowledge," with the "Standards of National Examination for Medical Practitioners." The major diseases and syndromes in "Essential Fundamentals" correspond to the basic diseases in Table 1 of the Core Curriculum, symptoms, physical and laboratory examinations, and treatment in "General Medicine" correspond to the items in Table 2 of the Core Curriculum, and the diseases in "Medical Theory" correspond to the diseases in PS-02 of the Core Curriculum. The validity of the diseases in the Core Curriculum was verified using the evaluation results of the examination level classification of the "Research for Revision of National Examination Criteria." Approximately 690 diseases were conclusively selected. This revision mentions the number of diseases in the Core Curriculum for the first time. Hopefully, this will lead to a deeper examination of diseases that should be studied in medical schools in the future.

　　Mushrooms that had been handpicked were butter-roasted and eaten by six neighborhood residents. All 6 individuals subsequently developed nausea within 60 min to 90 min after the meal. They requested an ambulance and were brought to our emergency department. The ambulance service staff mentioned the possibility that the ingested mushrooms were Lampteromyces japonicus. After admittance, symptomatic conservative treatment relieved the symptoms and all 6 individuals were discharged the next day. However, one patient was rehospitalized due to complaints of abdominal pain and anorexia and another patient was rehospitalized with complaints of vomiting and bloody stool 2 days after initial discharge. In the latter patient, abdominal computed tomography revealed marked wall thickening of the duodenum and jejunum. Typically, the symptoms caused by Lampteromyces japonicus are vomiting, diarrhea, and abdominal pain within 30 min to 3 h after ingestion, but intestinal edema may occur after a few days in severe cases.

　Purpose: Although a late-evening snack (LES) has been recommended to patients with chronic liver disease, the effects of long-term carbohydrate-enriched LES still remain debatable. The purpose of this study was to clarify the usefulness of the LES in outpatients with liver cirrhosis.　　Materials and Methods: A nutritional education using LES was given once every month during six months by registered dietitians and pharmacists to 23 outpatients with liver cirrhosis. Seventeen patients were graded A in light of Child classification, and six were graded B. The LES consisted of health foods such as rice balls and bread with 100-200 kcal carbohydrate. Serum AST, ALT, total bilirubin, total protein and albumin levels were evaluated before the nutritional education and 12 months after the start of the education.　　Results: The nutritional education was finished by 19 patients (82.9%). No significant differences were observed in AST, ALT, total bilirubin and total protein values between before and after the education. In 14 patients who were graded Child A and B after the education, with the exception of two patients graded Child C after the education, serum albumin concentrations after the education were significantly higher than those before the education.　　Conclusions: The long-term nutritional therapy with carbohydrate-enriched LES can be performed in the most efficient way on a large percentage of outpatients with liver cirrhosis. This nutritional therapy may be useful for liver cirrhosis patients so long as the liver functions fairly well.

Between March 1985 and May 1988 we performed valve replacement to 86 cases using 92 Duromedics prosthetic valves in the atrioventricular position. Long term results were obtained, we examined the problem (especially thrombosed valve). The cumulative follow-up was 313.6 patients-year (p-y). The 6-year actuarial survival rate including early mortality was 83.4±4.1%. The valve-related complications were as follows; peripheral embolism 3 cases (1.0%/p-y), thrombosed valve 7 cases (2.2%/p-y), hemorrhage and paravalvular leakage each 1 case (0.3%/p-y). All valve-related complications were 12 cases (3.8%/p-y). Reoperation for valve-related complications were 5 cases (1.6%/p-y), it was all to thrombosed prosthetic valve. Thrombosed valve were seen 7 cases (4 cases in mitral, 3 cases in tricuspid position). The event free rate of thrombosed valve was 89.1±4.0%. It was high incidence in tricuspid position. We concluded that it was necessary to be done early reoperation the time of fixed with one leaflet alone.