Background/Aims: Despite the advent of advanced therapies, cases of so-called “difficult-to-treat” (D2T) ulcerative colitis (UC) persist. This study aims to clarify the epidemiological and clinical characteristics of patients with D2T UC. Methods: We conducted a nested case-control study using the Medical Data Vision Claims Database in patients with UC who began an advanced therapy (biologics, advanced small molecules, calcineurin inhibitors) from January 2018 through April 2023. D2T UC patients were defined as having 2 or more switches of advanced therapies, or as undergoing surgery for UC, within 2 years after the first advanced therapy. Results: Four hundred and one (16.7%) and 1,996 patients (83.3%) met the definitions of patients with D2T UC and non-D2T UC, respectively. After 1:1 matching by index year, 355 patients per group were included in the analysis. Multivariate logistic regression analyses, including sensitivity analyses based on follow-up period after the first advanced therapy, showed that a prescribed corticosteroid dose of ≥ 30 mg/day during the 6-month baseline period was associated with D2T UC. In D2T UC patients, median duration of the first advanced therapy was 99 days, and median number of advanced therapies per year was 1.7. The first advanced therapy was continued for 2 years in 78% of patients with non-D2T UC. Conclusions The proportion of D2T UC patients among UC patients starting advanced therapy was 16.7%. The factor most associated with D2T UC was the need for a corticosteroid dose ≥ 30 mg/day during the 6 months before initiation of advanced therapy.

Purpose: The objective of this study was to assess the performance of ChatGPT (GPT-4) on all items, including those with diagrams, in the Japanese National License Examination for Pharmacists (JNLEP) and compare it with the previous GPT-3.5 model’s performance. Methods: The 107th JNLEP, conducted in 2022, with 344 items input into the GPT-4 model, was targeted for this study. Separately, 284 items, excluding those with diagrams, were entered into the GPT-3.5 model. The answers were categorized and analyzed to determine accuracy rates based on categories, subjects, and presence or absence of diagrams. The accuracy rates were compared to the main passing criteria (overall accuracy rate ≥62.9%). Results: The overall accuracy rate for all items in the 107th JNLEP in GPT-4 was 72.5%, successfully meeting all the passing criteria. For the set of items without diagrams, the accuracy rate was 80.0%, which was significantly higher than that of the GPT-3.5 model (43.5%). The GPT-4 model demonstrated an accuracy rate of 36.1% for items that included diagrams. Conclusion Advancements that allow GPT-4 to process images have made it possible for LLMs to answer all items in medical-related license examinations. This study’s findings confirm that ChatGPT (GPT-4) possesses sufficient knowledge to meet the passing criteria.

Objective：The movement of an elderly person involving stepping over a bathtub makes them prone to falls and requires caution. Gait analysis suggested that the risk of falling increases with time spent in supporting both legs. A similar relationship was expected for side-straddling motion. This study aims to analyze differences in the side-straddling movements between THA patients who did not fully recover their functional balance, mobility, or walking ability from the viewpoint of the ratio of time spent supporting both legs.Methods：Eleven patients with hip osteoarthritis underwent initial unilateral THA via a posterior approach. Using a portable three-dimensional motion analyzer, we calculated the percentages of time spent supporting both legs while entering the bathtub, and exiting the bathtub with a handrail and examined the factors associated with percent of the time spent supporting both legs.Results：The percentage of time spent supporting both legs when exiting the bathtub was significantly lesser when exiting using the nonoperative than the operated side. A negative correlation was found between the percentages of time spent supporting both legs. while exiting the bathtub, and the percentage of handrail load values.Conclusion：The risk of falling may be reduced by using the nonoperative leg as the leading leg when exiting a bathtub. Use of handrails contributes to a reduction in fall risk.

Team-based learning (TBL) is an educational method developed to cultivate the ability to solve problems by learning and applying knowledge on one's own, as well as the ability to make decisions, take responsibility, and collaborate by working on issues in small groups. TBL in Kampo medicine was held as a special program : active learning at the 71st Annual Meeting of the Japan Society for Oriental Medicine. A total of 57 students participated in the TBL session. The theme of the session was the common cold with the theory of yin and yang. According to the results of a questionnaire survey, the students answered that they were able to understand the flow of diagnosis in Kampo medicine, which was the goal of the course. As a bridge from classroom lectures to clinical practice, TBL in Kampo medicine was considered to be useful in Kampo medical education.

BACKGROUNDAlthough various studies have been conducted on the effects of radiation therapy for prostate cancer, rectal toxicity after radiation therapy for prostate cancer, which is an important late adverse event associated with radiation therapy, has not been sufficiently examined. This study aimed to assess the associations of late rectal disorder (LRD) with dosimetric, anatomic, and clinical factors in patients with prostate cancer who underwent three-dimensional conformal radiation therapy (3D-CRT).

METHODSWe retrospectively analyzed 104 patients undergoing 3D-CRT between January 2009 and October 2011. Thirty patients were administered anticoagulation/antiplatelet (AC/AP) agents. The standard dose was 74 Gy. Uni- and multi-variate analyses were performed to identify factors predictive of LRD after 3D-CRT.

RESULTSThe median follow-up period was 66 (range: 14-87) months. LRD occurred in 10.6% (11/104) of patients. The median time from RT to LRD was 15 months (range: 7-41 months). Sixty-four percent of those with LRD (7/11 patients) had been given AC/AP agents. Fifty-five (6/11) patients had severe internal iliac artery calcification. By univariate analysis, significant predictors of LRD were internal iliac artery calcification, administration of AC/AP agents, and age. Being very elderly was the significant predictor identified by multivariate analysis (P = 0.0276). For patients receiving AC/AP agents and those with severe internal iliac artery calcification, the LRD incidences were 23.3% (7/30 patients) and 23.1% (6/26 patients), respectively, and being 75 years of age or older was a significant predictor in these subsets.

CONCLUSIONSOur results suggest advanced age, administration of AC/AP agents, and severe internal iliac artery calcification to be risk factors for LRD in patients undergoing standard RT. Therefore, it is necessary to administer radiation with particular caution in the very elderly, especially those receiving AC/AP agents and/or with severe internal iliac artery calcification.

The saphenopopliteal junction (SPJ) is found at various levels and has various patterns compared with the saphenofemoral junction. Although this can cause difficulty in the surgical treatment of varicose veins and affect the outcome, there have been few reports on preoperative assessment of the small saphenous vein (SSV) regarding this point. This study was undertaken to evaluate three-dimensional CT venography with dual-route injection for the preoperative assessment of a small saphenous-type varicose vein. We examined a total of 15 legs in 15 patients with a small saphenous-type varicose vein, which were preoperatively evaluated by CT venography and then surgically treated. The patients included 4 men and 11 women with ages ranging from 50 to 80 years old (mean age, 66 years). The grading of varicose veins according to the CEAP classification was C2, C3, C4, and C5 in 3, 4, 6 and 2 legs, respectively. The CT imaging was performed with contrast medium diluted ten-fold, which was injected into the great and small saphenous veins simultaneously. CT venography clearly visualized the lower extremity veins. Whereas the popliteal vein coursed deep above the level of the femoral intercondylar groove, it followed a shallow course below the level of the knee joint. In 11 legs (74%), the SPJ was located in the shallow portion, whereas it was in the deep portion in 4 legs (26%). Among the former group, the SSV was connected to the great saphenous vein via the Giacomini vein in 2 cases, and the gastrocnemius vein was connected to the SSV before the SPJ in 3 cases. Among the latter group, a localized large venous aneurysm with thrombus before its termination was found in one case. In another case, the SSV showed branched termination in the deep portion. Our three-dimensional CT venography with dual-route injection provides more accurate information on venous anatomy in the lower extremity. The accuracy of images acquired by CT venography with dual-route injection was verified by intraoperative findings. Although Doppler ultrasound is essential for examining the presence of regurgitation in the veins and locating the course of a varicose vein in the surgical field, all 15 cases had scheduled surgery under local anesthesia based on accurate preoperative diagnosis. This study suggests that CT venography with dual-route injection is beneficial in preventing undesired complications during surgery and avoiding additional procedures for recurrent varicose veins.

Objective: To nurture pharmacists capable of contributing to the prevention of adverse reactions to psychotropic agents, the Sapporo Hospital Pharmacist Association has been holding a seminar for psychiatric pharmacy specialist.  A questionnaire survey was conducted to clarify the usefulness of this seminar and its future direction, and evaluate the necessity of providing information on psychotropic drugs.
Methods: An anonymous 21-item questionnaire was distributed to participants in the 2008 Sapporo Hospital Pharmacist Association seminar for psychiatric pharmacy specialist.
Results: The mean recovery rate was 76.3%, and the respondents had a broad background in terms of age, gender, etc.  The seminar was identified as being beneficial, and the participants’ awareness of the accreditation of Board Certified Pharmacist in Psychiatric Pharmacy showed regional characteristics.
Conclusion: Based on the survey results, guidelines on conducting the seminar in the future were successfully developed.  From now on, it is important to create an environment to nurture psychiatric pharmacy specialist in the Sapporo area.  Additional efforts should be made so that the provision of information on psychotropic drugs in the seminar can contribute to the prevention of adverse reactions to them.

We report a case of serous gonarthritis with nonproductive cough successfully treated with Eppikajutsuto. A 37-year-old Japanese man developed a right genicular arthrocele with nonproductive cough, in October X. Over 100 ml of serous synovial fluid was drained via an arthrocentesis puncture procedure. Although he was treated with nonsteroidal anti-inflammatory agents by an orthopedist, under a diagnosis of serous gonarthritis, his symptoms did not improve. Laboratory findings suggested inflammatory conditions (serum CRP 3.4 mg/dl, ESR 76 mm/h). At the time of his first visit in January X+1, orthopedic examinations revealed that rheumatoid arthritis was unlikely, based on negative physical and laboratory findings. A contrast MRI knee joint scan did not demonstrate any tumor-like mass of synovium which would indicate pigmented villonodular synovitis. And orthopedists found it difficult to specify the cause of his serous gonarthritis. After a common cold in December X, cough stimulated by cold exposure was superimposed on serous gonarthritis.We utilized Eppikajutsuto under the interpretation that both his genicular arthrocele and nonproductive cough were due to a “sui” disturbance. This Eppikajutsuto therapy reduced his genicular arthrocele and nonproductive cough in1month. His symptoms and inflammatory reactions were completely improved in 3 months, regardless of gradual withdrawal of his medication.
Coughing ; Upper case ecks ; symptoms <1> ; Serous ; Treated with

We demonstrated two patients with fibromyalgia syndrome (FMS), successfully treated with Kampo medicine, and considered the resemblance between the clinical manifestation of FMS and SHO for Kanzo-bushi-to.The first case was a 52-year-old women who consulted a local hospital in 2001 due to althralgia and myalgia in the left hand, bilateral elbows, shoulders and foot. Her condition was diagnosed as FMS without abnormal findings in the thorough medical examination. Treatment with NSAIDs was not effective, so she consulted our department in 2004. She was treated with Keishi-ni-eppi-itto-ka-ryojutsu-ka-boi-ogi-kakkon. After two mouths, her symptoms had reduced to 50% by visual analog scale (VAS). By March 2006, her symptoms had significantly decreased to 20% by VAS and NSAIDs became unnecessary.The second case was a 58-year-old woman who had suffered from tolerable pain in her right elbow for 10 years. In 2004, she visited the Department of Orthology at her local hospital due to pain in the neck, bilateral arms and shoulders. There were no findings on cervical X-ray or neurological examination, and NSAIDs were administered. Her symptoms did not resolve, therefore, she consulted our department in 2005. She was diagnosed with FMS, based on fulfilling the diagnostic criteria for FMS of ACR (American college of rheumatology) in 1990. She was treated with Kanzo-bushi-to. After 3 months, her symptoms had reduced to 30% by VAS. By Mar. 2006, her pain had redused to 25% by VAS and she was physically fit enough for a daily life.
CSF1-R ; symptoms <1> ; Medicine, Kampo ; Pain ; Fibromyalgia

We report a case with an intractable jugular sense of discomfort, with dryness and nonproductive cough successfully treated with soshikokito. A 62-year-old Japanese man developed jugular sense of discomfort with dryness and nonproductive cough, after odontotherapy in October. Although he was treated with Western drugs by an otolaryngologist, under the diagnosis of xerostomia with no mechanical problems, his symptoms did not disappear. The symptoms followed a protracted course, and he further developed a loss of appetite. At the time of first visit in October, otorhinolaryngological studies showed no structural lesions or problems, with the exception of minimum salivation in the normal range on a gum test. There was no evidence of dry eyes. With the diagnosis of xerostomia, Bakumondoto-go-hangekobokuto was administered for a month but showed no sign of improvement. Making a shift to bukuryoin-go-hangekobokuto regained his appetite, but did not produce any improvement on dryness. We then utilized soshikokito under the interpretation that both dryness and nonproductive cough is ki-gyaku. The soshikokito therapy reduced his dryness in a month's time. Additionally, his nonproductive cough gradually decreased, and within 11 months after, he had no symptoms, regardless of a gradual medication withdrawal.
Coughing ; symptoms <1> ; seconds ; month ; Peripartum discomfort