Purpose: Surgical resection of remnant gastric cancer (RGC) is technically challenging and difficult. Minimally invasive surgery (MIS) has been adopted for various procedures, but reports of MIS for RGC remain limited. Herein, we report the surgical techniques and short-term outcomes of MIS for RGC. Methods: We conducted a retrospective cohort study involving 61 consecutive RGC patients who underwent open or minimally invasive (laparoscopic or robotic) total gastrectomy for potentially curable RGC at our institution (January 1999–August 2025). A propensity scorematched cohort was used for an exploratory evaluation of the safety and efficacy of MIS for RGC, focusing on feasibility rather than superiority over open surgery. Results: Of these 61 patients, 53 underwent open surgery and eight underwent MIS gastrectomy for RGC. The median age was 70 years. The cohort comprised 53 men and eight women. The initial procedure was open surgery in 58 patients and MIS in three patients.Propensity score matching showed significantly reduced intraoperative blood loss in the MIS group compared with the open surgery group (39 mL vs. 576 mL, p < 0.05), and significantly longer operation time in the MIS group (352 minutes vs. 297 minutes, p < 0.05). Postoperative hospital stay was significantly shorter in the MIS group (12 days vs. 17 days, p < 0.05). The incidence of postoperative pancreatic fistula was lower in the MIS group, although not significantly different (0% vs. 16.7%). Conclusion MIS, including robotic gastrectomy, is feasible and safe for RGC, with potential perioperative benefits requiring multicenter validation.

BACKGROUND: We investigated the association between psychological distress and oral health status/oral health-related quality of life (OHQoL) in Japanese community-dwelling people. METHODS: We conducted a cross-sectional study using data from the Nagasaki Islands Study. A total of 1183 (455 men and 728 women) has been analyzed in this study. Psychological distress was measured using the Kessler Psychological Distress Scale (K6). Oral health status was measured by dental examination. The OHQoL was measured using the General Oral Health Assessment Index (GOHAI). We defined the total score of ≥5 points on the K6 as high psychological distress (high-K6 group). RESULTS: The multiple linear regression analysis to identify the GOHAI showed that gender, K6, the total number of teeth, the number of dental caries, and visiting a dental clinic within the past 6 months significantly associated with the GOHAI. Among all of these variables, high-K6 (≥ 5) was a substantial contributing factor of the GOHAI (β = - 0.23, 95% Cl - 2.31 to -1.41, p < 0.0001). CONCLUSIONS It is likely that the individual with high psychological distress was strongly related to poor OHQoL even in the general population.
Aged ; Cross-Sectional Studies ; Dental Caries/epidemiology* ; Female ; Humans ; Independent Living/statistics & numerical data* ; Japan/epidemiology* ; Linear Models ; Male ; Middle Aged ; Oral Health/statistics & numerical data* ; Quality of Life/psychology* ; Sex Factors ; Stress, Psychological/epidemiology*

Introduction: Tramadol (TRM) has been included as a weak opioid at the second step of the WHO analgesic ladder and has been widely used in palliative medicine. Here we report a case of amelioration of cancer pain by TRM therapy in a female patient with myasthenia gravis (MG). Case:The patient was a 70’s woman who was diagnosed with advanced endometrial carcinoma and suffered from chest pain caused by chest metastasis. 25 mg of a TRM capsule was orally administered three times a day. The dose was increased to 50 mg twice a day. It was resulted in sound pain relief with transient muscle weakness but without a myasthenic crisis.

In 1991, the committee on postgraduate clinical training proposed revised behavioral objectives for basic clinical training in the initial two years. We present here a model for a clinical training program that should enable most residents to attain these objectives within two years.
The program begins with orientation for 1-2 weeks, including a workshop on team care, and nursing practice.
Basic clinical skills for primary care and emergency managements should be learned by experience during rotations through various clinical specialities. All staff members, even senior residents, should participate in teaching beginning residents in hospitals.

Japanese medical graduates are recommended to receive clinical training for more than two years after graduation, because undergraduate clinical training is insuffiicient.
In 1976 the committee of postgraduate clinical training proposed the objectives of basic clinical training after graduation of medical schoool and in 1981 the committee proposed the objectives for the first postgraduate year of training and the methods of clinical skill assessment.
We here present the revised objectives of basic clinical training after graduation of medical school.
It is emphasized that clinical trainees should have basic clinical skills of primary and emergency care during the two year training.
These clinical skills include interviewing techniques, skills in physical examination and interpretation of physical findings, laboratory skills, skills relating to diagnosis and managements, communication skills to other doctors and to other medical co-workers and terminal care.