A commemorative lecture meeting on the inclusion of a new chapter of traditional medicine in ICD­-11 was held in Tokyo in February 2020. The head of the Collaborating Centre for WHO­-FIC in Japan explained the process of the project, which started in 2006 to increase WHO's data collection from developing countries and expressed gratitude to the concerned persons who made efforts to obtain consensus with China and Korea. WHO promoted integrated coding between traditional medicine and Western medicine. In the field of acu­puncture, meridian and collateral patterns proposed by Japan were adopted and research activities have begun. In the field of Kampo medicine, the prescription content is often used in a fixed form as a representative for­mula pattern in Japan, so clinically high­-level research will be possible under this new classification. In the field of medical information, it has been pointed out that there are high hurdles for medical information man­agers to understand traditional medicine. It is expected that the progress of mutual understanding of both medi­cines. From now on, activities in research, translation, education and dissemination of this new classification should be promoted.

This study investigated the characteristics of emergency patients, including walk-in patients and those brought in by ambulance, who visited Akita Kousei Medical Center in the 6 months from April 2019, and the clinical features of elderly patients with heart failure. Elderly patients above 70 years of age accounted for 38.7% of emergency cases and up to 61.7% of ambulance cases. The most common diseases and disorders were orthopedic, digestive, otorhinolaryngeal, respiratory, neurological, dermatological, and cardiovascular disease, in that order. In total, 56 patients with heart failure were admitted during this period (age 83.5±8.3 years, male: female ratio, 1:1.67). Hospitalization from homes accounted for 66.1% of admissions, with the remainder from nursing homes. After treatment, 35.7% of patients moved to nursing homes and 19.6% died despite in-hospital care. Because heart failure is one of the most common conditions in elderly patients, it is pertinent to recognize the importance of quality of outpatient care to prevent hospitalization and also to preserve quality of life by focusing on alleviating overall pain and discomfort.

In patients with unresectable hepatocellular carcinoma (HCC) without both macrovascular invasion and extrahepatic metastasis, the initial treatment choice recommended is transarterial chemoembolization (TACE). Before sorafenib came into wide use, TACE had been pointlessly carried out repeatedly. It was in the early 2010s that the concept of TACE refractory was advocated. Two retrospective studies from Japan indicated that conversion from TACE to sorafenib the day after patients were deemed as TACE refractory improved overall survival compared with continued TACE, according to the definition by the Japan Society of Hepatology. Nowadays, phase 3 trials have shown clinical benefits of several novel molecular target agents. Compared with the era of sorafenib, sequential treatments with these molecular target agents have gradually prolonged patients’ survival and have become major strategies in patients with HCC. Taking these together, conversion from TACE to systemic therapies at the time of TACE refractory, compared with before, may have a greater impact on survival and may be considered deeper in the decisions-making process in patients with unresectable HCC who are candidate for TACE. Up-to-date information on the concept of TACE refractory is summarized in this review. We believe that the survival of patients with unresectable HCC without both macrovascular invasion and extrahepatic metastasis may be dramatically improved by optimal timing of TACE refractory and switching to systemic therapies.

Endoscopic papillectomy (EP) for ampullary adenomas achieves cure rates ranging from 76% to 90%, and recurrence rates are as high as 33%. If remnant or recurrent lesions after prior EP are endoscopically visible and are not suspected of intraductal extension into the biliary or pancreatic duct, repeated snaring and cutting can be performed until all visible lesions are completely resected. However, endoscopic ablative therapies, particularly argon plasma coagulation, can be attempted for tiny or uncertain remnant and recurrent lesions. In addition, intraductal radiofrequency ablation has recently been attempted for residual intraductal lesions after EP at several institutions. Although still under investigation, it has shown some promise. It might be offered as an alternative to surgery, particularly in patients who are unfit for surgery or those who refuse to undergo surgery.

We aimed to evaluate the associations of individual-level social capital (SC) and physical activity (PA) among Japanese elderly men and women. Individuals aged 65 or above were selected via population-based random sampling of 3000 adults, aged 20 years or above and living in Fujisawa city, who were asked to complete self-administered questionnaires. The sample consisted of 260 men [median (25-75% tile) age 73 (68-78) yrs] and 274 women [73 (68-78) yrs]. The daily duration of PA, SC [e.g., norms of reciprocity (mutual support in the community), social networks (relationship with community people, exchange with other generations), social participation (participation in community organization activities)], socio-economic status [educational attainment, work with income, perceived household economic status], and demographic characteristics [sex, age, living arrangements, BMI, physical limitations] were assessed. Multivariate logistic regression analyses were used to calculate odds ratios (OR) for associations of SC with PA, stratified by sex. High level of mutual support in the community, relationship with community people, and exchange with other generations were associated with longer PA time in men after adjusting for potential confounders in the final model (OR = 2.40 (95% CI: 1.24-4.67), 5.28 (1.42-19.66), and 4.24 (1.15-15.67), respectively). In women, relationship with community people and participation in community organization activities were associated with longer PA time (3.10 (1.32-7.26) and 2.50 (1.27-4.91), respectively). The association of individual-level SC and PA differed between men and women. Future studies can investigate whether similar results can be obtained in other areas or attempt to conduct a large-scale survey.

STUDY DESIGN: Retrospective cohort study. PURPOSE: To investigate the effect of spinal correction on respiratory muscle strength in patients with Duchenne muscular dystrophy (DMD). OVERVIEW OF LITERATURE: Several studies have reported that scoliosis correction in patients with DMD does not improve pulmonary function. In these studies, pulmonary function was evaluated using the traditional spirometric values of percent vital capacity (%VC) and percent forced vital capacity (%FVC). However, traditional spirometry may not be suitable for patients with DMD because the results can be influenced by patient fatigue or level of understanding. Therefore, we evaluated respiratory function focusing on respiratory muscle strength using maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and sniff nasal inspiratory pressure (SNIP), in addition to %VC and %FVC. METHODS: We retrospectively reviewed 16 patients with DMD who underwent spinal correction surgery between 2006 and 2011 at Kitasato University Hospital. All patients were males, and the mean age was 13.5 years. Respiratory muscle strength was evaluated using MIP, MEP, and SNIP. Measurements were obtained preoperatively and at 1 and 6 months postoperatively, and %VC and %FVC were obtained preoperatively and within 6 months postoperatively. RESULTS: The mean preoperative and postoperative %VC values were 54.0% and 51.7%, whereas the mean %FVC values were 53.9% and 53.2%, respectively. The mean MIP, MEP, and SNIP values obtained preoperatively and at 1 and 6 months postoperatively were as follows: MIP, 40.5, 42.7 and 47.2 cm H₂O; MEP, 26.0, 28.0, and 29.0 cm H₂O; and SNIP, 33.4, 33.0, and 33.0 cm H₂O; respectively. The mean MIP and MEP values significantly improved postoperatively. There were no significant differences in SNIP, %VC, or %FVC preand postoperatively. CONCLUSIONS: By focusing on respiratory muscle strength, our results suggest that scoliosis correction in patients with DMD might have a favorable effect on respiratory function.
Cohort Studies ; Fatigue ; Humans ; Male ; Muscular Dystrophy, Duchenne* ; Respiratory Muscles* ; Retrospective Studies ; Scoliosis* ; Spirometry ; Vital Capacity

An 80-year-old man was referred to our hospital due to anorexia and loss of body weight. Blood examination showed a severe inflammatory reaction and Streptococcus oralis was detected in his blood culture. Echocardiogram demonstrated severe aortic valve regurgitation and vegetation located on the valve. Although we diagnosed infective endocarditis (IE) and started to treat with antibiotics, the patient refused treatment and was discharged. Ten days later, he was readmitted to our hospital because of chest pain. Electrocardiogram demonstrated an anteroseptal acute myocardial infarction and an emergency coronary angiogram revealed complete obstruction of the left anterior descending coronary artery (LAD). He was successfully treated with thrombus aspiration using a catheter device. Pathological examination of the thrombus revealed that the coronary embolism was caused by infective endocarditis (IE). To prevent re-embolization, we performed aortic valve replacement 8 days after the intervention and CABG was also carried out for residual stenosis on the LAD. Coronary embolism caused by IE is a rare problem. We reported a case of AMI associated with IE that was initially treated with thrombus aspiration which was followed by aortic valve replacement.

Local recurrence after endoscopic piecemeal mucosal resection (EPMR) for colorectal tumors is a crucial issue. However, such recurrence is usually detected within one year and cured with additional endoscopic treatment, which makes EPMR acceptable. Herein, we report a rare case of repeatedly recurrent colon cancer involving the appendiceal orifice after EPMR, which was not cured with additional endoscopic treatments. A 67-year-old man was referred to us for endoscopic treatment of a 25 mm cecal tumor spreading to the appendiceal orifice in May 2002. The tumor was resected with EPMR, showing well differentiated intramucosal adenocarcinoma with a positive lateral cut margin of tubular adenoma. Endoscopic surveillance was conducted and the first local recurrence was detected in August 2006. Although we resected it endoscopically, the second local recurrence was found in September 2007 and we removed it with endoscopic resection again. However, the third local recurrence was detected in March 2008. Although endoscopic resection was performed also for the third recurrence, curative resection was not achieved. In February 2009, laparoscopic assisted colectomy was performed and histopathological examination showed well differentiated adenocarcinoma with deep submucosal invasion. This case is important in considering indication for endoscopic resection in colorectal tumors involving the appendiceal orifice.
Adenocarcinoma/*diagnosis/pathology/surgery ; Aged ; Appendiceal Neoplasms/complications ; Colectomy ; Colonic Neoplasms/*diagnosis/pathology/surgery ; Colonoscopy ; Humans ; Intestinal Mucosa/pathology ; Male ; Neoplasm Recurrence, Local ; Recurrence

We evaluated the influence of a twice-weekly group exercise program on visceral fat area (VFA) and plasma adiponectin (APN) in the elderly. Thirty-three community-dwelling elderly (age : 72.4±6.9 yrs) participated in a 12-week supervised, geriatric exercise training program (GET) followed by a 12-week unsupervised GET (u-GET), which included stretching, strengthening, and balance-training exercises. Participants were evaluated for physical fitness, blood glucose, HbA1c, triglyceride, cholesterol, insulin, and APN. VFA was measured by computed tomography. All measurements were taken before the GET (TR1), after 12-weeks of GET (TR2), and at the end of the u-GET (TR3). Twelve weeks of GET produced significant increases in physical function measures. Both walking speed and functional mobility values at TR3 were significantly higher than TR1 values. A significant reduction in VFA was seen at TR3 in men. APN progressively elevated from TR1 to TR3 in women. In the frail elderly, 12 weeks of GET effectively increased functional ability and APN. The beneficial effects on VFA and APN were sustained following the participation in the unsupervised setting, suggesting that the frail elderly should be encouraged to participate and maintain a resistance training routine to achieve preferable effects on both functional ability and cardiovascular risk factors.