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 recent years, depression has become diverse, particularly in the younger population. In the field of medical education, it is assumed that a number of educators often experience difficulties in attending to their learners with depression. In this review article, information which contributes to the promotion of mental health for medical residents is provided, considering the knowledge of recent depression in the younger population, including its diversity together with the characteristics of the "generation educated with latitude".

　The education program in all medical schools in Japan has been studied and analyzed every 2 years since 1974 by the curriculum committee of the Association of Japan Medical Colleges. Based on the most recent analysis in 2015, the marked innovation of medical education, such as an integrated curriculum, active learning, and clinical clerkship, was recognized.

With the diagnosis of metastatic tumor of the lung suspected, we had a chance to experience a histopathological case of carcinoma of the uterine cervix (adenoid squamous cell carcinoma), which was thought to coexist with carcinoid tumor. In this paper, we report the results of cytological as well as histological examinations of the case.
The patient was as 43-year-old woman. She visited our hospital, complaining about abnormally prolonged uterine bleeding (metrorrhagia). Cytodiagnosis was performed with a Papanicolaou smear. A microscopic examination revealed squamous cell carcinoma occurring together with adenocarcinoma. A similar finding was obtained by cervical biopsy. Thus, the case was diagnosed as adenoid squamous cell carcinoma.
Then the patient underwent radical hysterectomy and lymphadenectomy, followed by chemotherapy. After leaving the hospital, she was put under doctor-monitored observation. About 4 years after the surgery, a chest x-ray examination found abnormal shadows. For inspection, bronchoscopy was performed. Carcinoid of the lung was diagnosed through histopathological as well as electron microscopic examination of specimens taken from bronchial polyps during bronchoscopy. At the same time a cytologic study was conducted. It also revealed neoplasms strongly suspected of caricinoid tumors. Retrospective studies of cytological and histopathological images of the uterine cervix when the patient first visited us found only adenocarcinoma and squamous cell carcinoma, but no signs of carcinoid tumors. However, the immunohistological staining of NSE and chromoganins A, both neuroendocrine markers, showed positive findings in some adenocarcinomatous parts of the tissues of the unterine cervix. Therefore, we considered that the cervical cancer is compounded of adenoid squamous cell carcinomas and tumors having properties of neuroendocrine cells.
From this, we concluded that it is necessary to take into account a differential diagnosis of neuroendocrine tumors including carcinoid of the uterine cervix when less differentiated adenocarcinoma and squamous cell carcinoma are suspected in histological and cytological examinations. Furthermore, we thought it important to make a definite diagnosis after meticulous examinations by immunohistological staining and electron microscopy.

Sixty-five patients who complained of various unidentified symptoms (undefined clinical syndrome), including 59 with climacteric syndrome, received Kampo medicine for eight weeks or more according to scores for their body constitution. Saiko-keishi-kankyo-to was given to those with a deficient constitution, Saiko-karyukotsu-borei-to to those with a robust constitution, and Kami-shoyo-san to those with a medium constitution.
A deficient constitution was more common among those aged 40 to 49, while those with a robust constitution increased in patients aged 50 to 59. The pretreatment climacteric index was comparable among the three groups, and most of them were mild to moderate. The faces of those with a robust constitution had more gloss and a tenser texture while those with deficient constitution were paler and had a face with less of a tense texture. Other signs such as a repeated epigastric splashing sound, hypochondriac resistance, dark rings around the eyes, dark purple tongue, and paraumbilical resistance were similar between those with robust and deficient constitutions. These signs were mild and observed in about 90% of patients. They therefore appear to be common signs among patients suffering from undefined clinical syndrome.
The severity of conditions determined by the mean value of the climacteric index was moderate among those with robust to medium constitutions and mild among those with deficient constitutions. The index was reduced to the normal values within two weeks of starting Kampo medicine in those with a deficient constitution, within six weeks in those with a medium constitution, and within eight weeks in those with a robust constitution. The mean values of clinical laboratory test results and hormone levels remained unchanged during treatment (eight weeks).
The overall improvement rating (“markedly improved” plus “improved”) was high (80%) in those with a deficient constitution, and slightly above 60% in those with a medium and a robust constitution. Safety was very high in all Kampo medicine used. The clinical value (“very useful” plus “useful”) was highest with Saiko-keishi-kankyoto given to those with a deficient constitution, followed by Kami-shoyo-san given to those with a medium constitution and Saiko-ka-ryukotsu-borei-to given to those with a robust constitution in that order.