Objective: We investigated the health-related quality of life (HRQoL) of patients with chronic diseases in community pharmacies in Japan and examined its relationship to patient attributes, an area that has not been previously studied.Method: We surveyed 1,500 participants with chronic diseases and 1,500 from the general population without chronic diseases (Free-GP) using the EuroQol (5-dimension, 5-level) questionnaire. Patient attributes included the number of drugs used, duration of medication, number of chronic conditions, perceived disease severity, and perceived treatment importance. Logistic regression analyses assessed how these attributes influenced the likelihood of reporting “full health” (no problems on all HRQoL questions) among patients with chronic disease. An exploratory decision tree analysis was performed to identify patient attributes that might decrease HRQoL.Result: The HRQoL score of patients (0.856) was lower than that of Free-GP (0.942). The HRQoL of patients tended to increase with aging. Among patients, the mean HRQoL score was 0.781 for polypharmacy, which decreased with the addition of disease severity perception (even lower for those in their 20s-40). Even in the absence of polypharmacy, the average HRQoL score decreased when patients were in their 20s with multimorbidity. The HRQoL scores of non-polypharmacy patients in their 30s or older were higher than the mean scores of patients with chronic disease.Conclusion: To provide extensive care for patients with reduced HRQoL in community pharmacies, it is necessary to focus on polypharmacy. Reduced HRQoL should be considered in younger patients with multimorbidity, even in the absence of polypharmacy.

The COVID-19 pandemic has substantially transformed the healthcare sector. While telemedicine has rapidly advanced, the essential roles of medical professionals, such as doctors and nurses, have been reaffirmed. Even prior to the pandemic, we had been evaluating pharmacists’ interpersonal roles from both patient and pharmacist perspectives using role theory. Accordingly, we investigated whether perceptions of pharmacists’ roles changed among patients and pharmacists through comparable surveys conducted before and during the pandemic. A nationwide online survey was conducted twice (April 30-May 7, 2021, and April 22-25, 2022), targeting 1,000 patients who used community pharmacies and 600-800 pharmacists employed at those pharmacies across Japan. The questionnaire comprised 12 items： 11 concerning pharmacists’ interpersonal roles, including communication, comprehending medication effects, and serving as a family pharmacist or drug expert, and one additional item addressing expectations during the pandemic. A five-point Likert scale was used. Compared with pre-pandemic results, patient evaluations revealed no statistically significant changes in either 2021 or 2022. However, pharmacists’ self-evaluations declined in response to the question, “Are pharmacists more expert in medicine than doctors?” The newly introduced question regarding pharmacists’ contributions to the community received higher ratings from patients than from pharmacists, indicating considerable patient expectations. Overall, only pharmacists’ perceptions changed, demonstrating decreased confidence and self-evaluation. Conversely, patient perceptions remained stable, suggesting that pharmacists are more sensitive to social changes than patients themselves.

While nonocclusive mesenteric ischemia (NOMI) has been reported in a significant percentage of adults who were resuscitated after cardiac arrest, it is rare in children. This report presents the first known Japanese case of pediatric NOMI after return of spontaneous circulation following cardiac arrest. A 16-month-old boy experienced cardiac arrest due to asphyxiation from foreign bodies in the airway. After receiving 10 doses of adrenaline, with a maximum arrest time of 95 minutes, the patient achieved return of spontaneous circulation. However, 40 hours after onset, the patient developed NOMI, resulting in refractory hypotensive shock with decreased blood pressure, distended abdomen, and increased intravesical pressure. The patient was successfully rescued with two laparotomies and was discharged. Although NOMI is uncommon in children, appropriate treatment can be lifesaving.

Tirzepatide has demonstrated greater efficacy than semaglutide in improving glycemic control and reducing body weight in patients with type 2 diabetes mellitus (T2DM). However, the optimal tirzepatide dose following a switch from 1.0 mg of semaglutide remains unclear. This retrospective study included 15 T2DM patients who switched to tirzepatide due to inadequate weight loss. All patients started tirzepatide at 2.5 mg, with escalation to either 7.5 mg (n=10) or 10 mg (n=5). Changes in glycated hemoglobin (HbA1c) and body weight were assessed over a 3-month period. The 10 mg group experienced a significant reduction in HbA1c (−0.7%±0.3%, P<0.01) and a non-significant trend toward weight loss (−6.6±5.4 kg, P=0.07). In contrast, no significant changes were observed in the 7.5 mg group. There were no statistically significant differences between groups. Since 10 mg of tirzepatide significantly improved glycemic control after switching from 1.0 mg of semaglutide, early escalation to 10 mg may be beneficial for patients who respond inadequately to semaglutide.

Objective：Only 44 of the 82 university medical schools in Japan have rehabilitation medicine departments, although rehabilitation medicine is one of the 19 basic specialties recognized by the Japanese Medical Specialty Board, and many medical doctors are concerned regarding selecting rehabilitation medicine as a basic specialty without sufficient education in the field. The “Let's Become a Physiatrist” Seminar has been organized since 2017 to eliminate such concerns, and this study aimed to investigate how these results are manifested in the number of majors.Methods：We examined the number of past attendees and tracked how many of them became rehabilitation medicine majors.Results：The number of seminar attendees over a 5-year period was 589. The number of on-demand viewers in FY2020 and FY2021, which were held via the web, was 554. A total of 116 of the 471 physicians who began specialty training in rehabilitation medicine after the seminar was planned attended or web viewed the seminar accounting for 24.63％．This percentage has been increasing each year, with 36.81％ of the majors who applied in 2022 attending the seminar, and the number of multiple attendees also increased. The number of majors has increased significantly doubling to 144 in 2022 compared with 74 in 2018.Conclusion：In many cases, the seminar helped the attendees learn more about physiatrists and develop their thoughts while attending multiple times. Thus, they started their majors. Five years have passed since we started planning this seminar, and we believe that the results are now coming to fruition.

The case involved a one-month-old male infant. Around two weeks after birth, cold-like symptoms were observed within the family. Over the course of approximately one month, the infant gradually developed coughing, apnea, and cyanosis, leading to a visit to a nearby medical facility. The episodes of apnea were initiated by a wet-sounding, choking cough. Respiratory pathogen multiplex screening revealed rhinovirus infection. The infant was managed in the intensive care unit and treated with a high-flow nasal cannula (HFNC), which resulted in an improvement of the recurrent episodes of apnea. We discontinued HFNC on the 7th day of hospitalization; however, the patient had recurrence of apnea. After relieving abdominal distension through rectal enema, the infant was successfully weaned off HFNC and discharged on the 14th day of hospitalization. In addition to the immaturity of the respiratory center in infants, laryngeal chemoreflex triggered by chemical receptors in the larynx is known to contribute to apnea. In the present case, we considered that the reduction of respiratory effort through HFNC, the expectorant effect of warmed and humidified air, and the decrease in gastroesophageal reflux due to alleviation of abdominal distension played roles in the successful outcome.

Objective：Only 44 of the 82 university medical schools in Japan have rehabilitation medicine departments, although rehabilitation medicine is one of the 19 basic specialties recognized by the Japanese Medical Specialty Board, and many medical doctors are concerned regarding selecting rehabilitation medicine as a basic specialty without sufficient education in the field. The “Let's Become a Physiatrist” Seminar has been organized since 2017 to eliminate such concerns, and this study aimed to investigate how these results are manifested in the number of majors.Methods：We examined the number of past attendees and tracked how many of them became rehabilitation medicine majors.Results：The number of seminar attendees over a 5-year period was 589. The number of on-demand viewers in FY2020 and FY2021, which were held via the web, was 554. A total of 116 of the 471 physicians who began specialty training in rehabilitation medicine after the seminar was planned attended or web viewed the seminar accounting for 24.63％．This percentage has been increasing each year, with 36.81％ of the majors who applied in 2022 attending the seminar, and the number of multiple attendees also increased. The number of majors has increased significantly doubling to 144 in 2022 compared with 74 in 2018.Conclusion：In many cases, the seminar helped the attendees learn more about physiatrists and develop their thoughts while attending multiple times. Thus, they started their majors. Five years have passed since we started planning this seminar, and we believe that the results are now coming to fruition.

Objective: Ovarian clear cell carcinoma (OCCC) is a subtype of epithelial ovarian carcinoma with poor prognosis. However, no effective biomarkers have been established for predicting unfavorable events, including recurrence and poor prognoses. Serum microRNAs (miRNAs) have been increasingly reported to be useful in predicting a patient’s condition and have been recognized as a potentially less-invasive source for liquid biopsy in cancer. Therefore, this study aimed to evaluate serum miRNA profiles from patients with OCCC and to establish biomarker for predicting the prognoses. Methods: The GSE106817, which included preoperative serum miRNA profiles of patients with ovarian tumors, was used, and clinical information was investigated. In all, 66 patients with OCCC were included, excluding those with other histological subtypes or insufficient prognostic information. Moreover, miRNA profiles of OCCC tissues were also examined. Results: The median follow-up period was 64.3 (8.0–153.3) months. Based on multivariable Cox regression analyses and the expression of miRNAs in OCCC tissues, miR-150-3p, miR-3195, and miR-7704 were selected as miRNA candidates associated with both progression-free survival (PFS) and overall survival (OS). Then, the prognostic index was calculated based on expression values of 3 serum miRNAs. Kaplan-Meier survival analysis indicated that the prognostic index was significantly predictive of PFS and OS (p=0.004 and p=0.012, respectively). Conclusion Preoperative serum miRNA profiles of miR-150-3p, miR-3195, and miR-7704 can be used to potentially predict the prognosis of patients with OCCC.

Uterine leiomyosarcoma (ULMS) is one of the most aggressive gynecological malignancies. In the past decade, novel therapeutic agents such as trabectedin and pazopanib have been approved, but the prognosis of patients remains unsatisfactory. This study aimed to identify potential therapeutic targets for ULMS based on transcriptome analysis. Archival fresh-frozen tumor tissues of 6 ULMS and three leiomyoma samples were used in this study, and total RNA was extracted. First, transcriptome analysis identified 512 significantly differentially expressed genes, and subsequent pathway analysis using IPA software revealed that the functions of cell cycle-related kinases were significantly activated in ULMS. Moreover, our results were validated using 3 independent Gene Expression Omnibus datasets, including 40 ULMS. Therefore, we considered the kinases as novel therapeutic targets and evaluated the anti-cancer effects of several selective inhibitors against them. Most inhibitors exerted a higher anti-cancer effect than pazopanib in three leiomyosarcoma cell lines. Especially, CHEK1 or PLK1 inhibitors strongly induced cell cycle arrest and cell death, and the IC50s were lower nanomolar concentration. Moreover, the inhibitors suppressed the tumor growth in SK-UT-1 bearing mice models. In conclusion, we revealed the unique gene expression profiles of ULMS. CHEK1 and PLK1 are promising therapeutic targets for ULMS, and therefore, further clinical trials are highly anticipated to improve the prognosis of the patients.

Locally advanced breast cancer (tumor > 5 cm, widespread infiltration of the skin and muscle, or metastases to lymph nodes) is difficult to resect by surgery, and even when it is resectable, there is a high probability of local recurrence and distant metastasis. Therefore, systemic therapy should be administered first. However, as cutaneous infiltration progresses, the patient's quality of life is impaired by pain, bleeding, presence of exudates, and a foulsmelling odor. Treatment with Mohs paste with systemic therapy can control symptoms associated with skin infiltration and can also be expected to decrease tumor volume.Herein, we report a case in which a tumor was resected following Mohs paste and systemic chemotherapy administration, and the skin defect was reconstructed with a latissimus dorsi myocutaneous flap. We also review the literature for previously reported cases of breast cancer involving Mohs paste.