The Common Achievement Tests for medical students consists of Computer Based Testing (CBT) conducted before clinical training, and Objective Structured Clinical Examination (OSCE) conducted before and after clinical training. Since the publicization of the Common Achievement Tests for medical students before clinical training in 2023, the Committee for Reasonable Accommodation has been established within the Common Achievement Tests Organization (CATO), where reasonable accommodations for each exam are being considered. Reasonable accommodations begin with an assessment based on requests from candidates and proceed through constructive dialogue between candidates and universities. Additionally, recordings of practical training sessions are provided to facilitate objective assessments, enabling the provision of reasonable accommodations tailored to candidates’ participation in clinical training and internships, thereby ensuring smooth examination processes.

Thoracic Endovascular Aortic Repair (TEVAR) is widely used for high-risk patients with thoracic aortic pathology. However, access to the thoracic aorta can be difficult because TEVAR requires the introduction of a large a sheath especially in those with aortoiliac occlusive diseases and thoracic shaggy aorta. We herein report two cases of TEVAR in which the common carotid artery was used as the access route. Case 1 : An 86-year-old male patient whose past surgical history was significant for infected abdominal aortic aneurysm with abdominal aortic stump closed and axillo-bilateral femoral bypass. Computed tomography revealed a saccular aneurysm of the descending aorta, which required a carotid artery approach as the access route. Case 2 : A 79-year-old female patient who developed type A thoracic aortic dissection. She was considered to be of prohibitive risk for surgical repair and was treated conservatively. However, an intramural hematoma with an ulcer-like projection lesion in the ascending aorta expanded and definitive treatment was indicated. Because the descending aorta was significantly shaggy, we decided to perform TEVAR via the right common carotid artery as the access route. Both patients' pathology was successfully treated and were discharged without any complications. TEVAR via common carotid artery access is a useful and safe procedure for patients in whom femoral and abdominal aortic aorta access is not feasible or safe.

Objective: Lenvatinib is an oral multitarget tyrosine kinase inhibitor (mTKI) and is recommended for patients with advanced hepatocellular carcinoma (HCC) with Child-Pugh A liver function, who are not amenable to surgical resection, locoregional treatment, or transcatheter arterial chemoembolization. Hepatogastric fistula is a rare complication with a poor prognosis in patients with HCC. Previous reports on fistula formation during mTKI therapy for HCC were all associated with sorafenib. Here, we report the first case of recurrent hepatogastric fistula during lenvatinib therapy for advanced HCC managed using an over-the-scope clip (OTSC).Patient: We present the case of a 73-year-old man with alcoholic liver cirrhosis who was treated for multiple HCC for 7 years. HCC was treated using repetitive transcatheter arterial chemoembolization, radiofrequency ablation, and sorafenib. Owing to disease progression, lenvatinib treatment was started. During lenvatinib treatment, recurrent hepatogastric fistulas developed. An OTSC was useful for fistula closure and prevention of recurrence.Results: The major cause of fistula formation is considered to be the direct invasion of HCC; however, HCC treatment might also be a contributing factor in our case. In addition, OTSC was useful for fistula closure.Conclusion: Clinicians should be aware of the fatal complications during HCC treatment.

Liposarcoma is one of the most common types of soft tissue sarcomas and can develop at any site, although omental liposarcoma is extremely rare. Omental liposarcoma has a poor prognosis because the diagnosis is difficult, until it presents as a large tumor causing severe noticeable clinical symptoms. A 51-year-old male with lower abdominal pain was referred to our clinic. Abdominal ultrasonography revealed an ill-defined, solid, heterogeneous, and hypoechoic tumor deep in the lower abdomen. Generally, liposarcomas are hyperechoic, though 20% of liposarcomas present as hypoechoic tumors. This variation might occur depending on the pathological classification. We should consider the possibility of a dedifferentiated component if ultrasonography reveals typical features of soft tissue sarcoma with hypoechoic lesion.

BACKGROUND/AIMS: Although daclatasvir with asunaprevir was approved in Japan for interferon ineligible or intolerant patients, patients aged ≥75 years were excluded in the phase III trial. The present study aimed to evaluate the safety and efficacy of this therapy for elderly patients aged ≥75 years and to clarify whether an extremely high sustained virological response (SVR) rate can be achieved, even in a real-world setting when patients with resistance-associated substitutions (RASs) to nonstructural protein 5A (NS5A) inhibitors or prior simeprevir failure are excluded. METHODS: Daclatasvir (60 mg) and asunaprevir (100 mg) were orally administered daily for 24 weeks. Patients without pre-existing NS5A RASs and simeprevir failure were enrolled in this study. RESULTS: Overall, 110 patients were treated. The median age was 73 years old. The SVR rates of total patients, those aged ≥75 years, and those aged < 75 years were 97% (107/110), 98% (46/47), and 97% (61/63), respectively. The treatment of two patients (2%) was discontinued because of adverse events. CONCLUSIONS: Daclatasvir with asunaprevir was a safe treatment, even in patients aged ≥75 years. When patients without pre-existing NS5A RASs and prior simeprevir failure were selected, an extremely high SVR rate could be achieved irrespective of age.
Aged ; Hepacivirus ; Humans ; Interferons ; Japan ; Simeprevir

BACKGROUND/AIMS: The present study aimed to evaluate the safety and efficacy of simeprevir-based triple therapy with reduced doses of pegylated interferon (PEG-IFN) and ribavirin for interferon (IFN) ineligible patients, such as elderly and/or cirrhotic patients, and to elucidate the factors contributing to a sustained virologic response (SVR). METHODS: One hundred IFN ineligible patients infected with genotype 1b hepatitis C virus (HCV) were treated. Simeprevir (100 mg) was given orally together with reduced doses of PEG-IFN-α 2a (90 μg), and ribavirin (200 mg less than the recommended dose). RESULTS: The patients’ median age was 70 years, and 70 patients were cirrhotic. Three patients (3%) discontinued treatment due to adverse events. The SVR rate was 64%. Factors that significantly contributed to the SVR included the γ-glutamyl transferase and α-fetoprotein levels, interleukin-28B (IL28B) polymorphism status, and the level and reduction of HCV RNA at weeks 2 and 4. The multivariate analysis showed that the IL28B polymorphism status was the only independent factor that predicted the SVR, with a positive predictive value of 77%. CONCLUSIONS: Simeprevir-based triple therapy with reduced doses of PEG-IFN and ribavirin was safe and effective for IFN ineligible patients infected with genotype 1b HCV. IL28B polymorphism status was a useful predictor of the SVR.
Aged ; Genotype* ; Hepacivirus* ; Hepatitis C* ; Hepatitis* ; Humans ; Interferons* ; Multivariate Analysis ; Ribavirin* ; RNA ; Simeprevir ; Transferases

The purpose of this study was to investigate the effects of Lactobacillus gasseri OLL2809 (MG2809) intake on salivary secretory immunoglobulin A (SIgA) secretion and incidence of upper-respiratory tract infection (URTI) symptoms among college rugby athletes. Sixty-seven subjects were assigned to a MG2809 group (n = 33) or a placebo group (n = 34) using a double-blind procedure. Each subject took MG2809 or placebo tablets for 9 weeks. Resting saliva samples were collected before (0 week) and after 2, 4, 6, 8, and 9 weeks of the MG2809 intakes. A log of URTI symptoms was kept every day during the study period. Our results showed that salivary SIgA level was significantly increased at 6 weeks in the MG2809 group (p < 0.05), although the placebo group did not show significant change. The duration of URTI symptoms episode in the MG2809 group was significantly shorter than that in the placebo (p < 0.05). These results suggest that regular intake of MG2809 may enhance oral immune function mediated by SIgA and reduce the risk of URTI in athletes.

Objective: The purpose of this study was to examine the effects of Coenzyme Q10 (CoQ10) supplementation on salivary secretory immunoglobulin A (SIgA) and health-related Quality of Life (QOL) in middle-aged and elderly individuals. Methods: Sixty healthy middle-aged and elderly individuals were assigned randomly to a CoQ10 supplementation group (n = 30) or a placebo supplementation group (n = 30) using a double blind method. Subjects took 150 mg CoQ10 or placebo per day for 8 weeks. Salivary SIgA secretion rate and SF-36 test (physical and mental health-related QOL) were determined before and after the intervention. Results: CoQ10 group showed that a tendency to increase of salivary SIgA secretion rate (p = 0.08), although placebo group did not show significant change. Physical health-related QOL did not significantly change in both groups. Vitality and mental health scores, which were subscale of mental health-related QOL, were significantly increased after the intervention in CoQ10 group (p < 0.05), although placebo group did not show significant change. Conclusion: 8 weeks of CoQ10 supplementation may bolster SIgA-mediated oral immunity and mental health-related QOL in middle-aged and elderly individuals.

The purpose of this study was to investigate the relation between alterations of salivary secretory immunoglobulin A (SIgA) and the occurrence of upper respiratory tract infections (URTI) in rugby football players.We examined the relationship between the onset of URTI and the daily alterations of SIgA levels in 32 male collegiate rugby football players (20.5±1.3 years) during summer training camp for 36 days.Total of 6 in 32 subjects had the appearance of URTI symptoms (18 %). SIgA secretion rate decreased significantly in the middle of training camp compared to the baseline (P＜0.05). Furthermore, SIgA secretion rate during the appearance of URTI (13.7±1.1μg/min) were significantly lower than that without symptoms (19.2±1.4 μg/min, P＜0.01). These results suggest that serial monitoring of SIgA may be useful to assess the risk status of URTI affection in athletes.

ObjectiveTo explore the relationship between thermography patterns and the clinical features of thalamus hemorrhage in the recovery period. MethodsTwo hands skin temperature of 32 patients with thalamus hemorrhage were measured with infrared heat radiation imaging 1 month after the stroke. Results21(66%) of 32 patients showed different imaging patterns between the affected limbs and the healthy sides. Of the 25 palsy patients, 18 (72%) showed abnormal images, just 3 of 7(42.6%) patients with normal muscle force showed abnormal images, and the difference was significanct(P<0.05). There was no relation between sensory disorder and imaging pattern. Patients with hematom lager than 10 millilitre showed more abnormal images than those with hematom under 10 millilitre(P<0.05). Patients with a course within 3 months had a tendency to show hot pattern, while those with a course beyond 3 month showed cold pattern. Conclusion There are certain relations between thermograpy patterns and the symptoms, signs of thalamus hemorrhage.