Dominant dystrophic epidermolysis bullosa (DDEB) is a rare inherited skin disorder characterized by extreme fragility of the skin and mucosa that poses significant challenges for anesthetic management. Herein, we report a case of a 65-year-old woman with DDEB who underwent a 13-hour surgery for mandibular cancer under general anesthesia. To prevent skin and mucosal injuries, meticulous perioperative strategies were implemented, including the use of barrier films and pressure-relieving pads and avoiding adhesive devices. High-flow nasal cannula oxygenation enabled awake fiberoptic intubation without the need for mask ventilation, minimizing the risk of blister formation and airway trauma. Despite the prolonged duration, no pressure ulcers or new skin injuries developed, other than minor epidermal peeling of the lips. This case demonstrates that comprehensive preoperative planning and intraoperative protection can ensure safe anesthesia in patients with DDEB undergoing long surgical procedures.

Introduction: This study examines the relationship between learning styles and outcomes of interprofessional education (IPE) through co-curricular learning for medical and welfare students.Method: To analyze changes over time, we utilized IPE evaluations of students from Nagasaki University School of Medicine and the Department of Comprehensive Community Care Services, Nagasaki Junshin Catholic University, who participated in either face-to-face or online classes.Results: The learning outcomes from medical and welfare perspectives in IPE significantly increased regardless of the learning style. As for the same perspective on students from each department, the value of many outcomes in face-to-face learning showed significant increases compared to online classes.Discussion: The learning outcomes of IPE in medical and welfare through online classes were considered to have achieved certain results. Additionally, differences in learning outcomes depending on the learning style were thought to be due to variations in understanding between the groups. It was suggested that long-term studies are necessary for effective co-curricular learning in the future.

OBJECTIVE: This study estimated the effects of weekend and off-hour childbirth and the size of perinatal medical care center on the incidence of cerebral palsy. METHODS: The cases were all children with severe cerebral palsy born in Japan from 2009 to 2012 whose data were stored at the Japan Obstetric Compensation System for Cerebral Palsy database, a nationally representative database. The inclusion criteria were the following: neonates born between January 2009 and December 2012 who had a birth weight of at least 2000 g and gestational age of at least 33 weeks and who had severe disability resulting from cerebral palsy independent of congenital causes or factors during the neonatal period or thereafter. Study participants were restricted to singletons and controls without report of death, scheduled cesarean section, or ambulance transportation. The controls were newborns, randomly selected by year and type of delivery (normal spontaneous delivery without cesarean section and emergency cesarean section) using a 1:10 case to control ratio sampled from the nationwide Japan Society of Obstetrics and Gynecology database. RESULTS: A total of 90 cerebral palsy cases and 900 controls having normal spontaneous delivery without cesarean section were selected, as were 92 cerebral palsy cases and 920 controls with emergent cesarean section. A significantly higher risk for cerebral palsy was found among cases that underwent emergent cesarean section on weekends (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.06-2.81) and during the night shift (OR 2.29, 95% CI 1.30-4.02). No significant risk was found among normal spontaneous deliveries on weekends (OR 1.63, 95% CI 0.97-2.73) or during the quasi-night shift (OR 1.26, 95% CI 0.70-2.27). Regional perinatal care centers showed significantly higher risk for cerebral palsy in both emergent cesarean section (OR 2.35, 95% CI 1.47-3.77) and normal spontaneous delivery (OR 2.92, 95% CI 1.76-4.84). CONCLUSION Labor on weekends, during the night shift, and at regional perinatal medical care centers was associated with significantly elevated risk for cerebral palsy in emergency cesarean section.
Case-Control Studies ; Cerebral Palsy ; epidemiology ; etiology ; Delivery, Obstetric ; statistics & numerical data ; Health Facilities ; statistics & numerical data ; Humans ; Incidence ; Infant, Newborn ; Japan ; epidemiology ; Parturition ; Perinatal Care ; statistics & numerical data ; Retrospective Studies ; Time Factors

Objective: To propose the best pharmacovigilance plan in Japan by comparing post marketing safety studies in Japan and the U.S.
Method: Among all of the newly approved medicines in Japan in 2010, 12 marketed products in the U. S. are selected. First, to examine the U. S. system, post-marketing safety concerns over those drugs at the time of approval in the U. S. were collected as well as its postmarketing requirements (PMR) which are studies or clinical trials that sponsors are required to conduct under one or more statutes of regulations. Then, the same drugsʼ safety issues discussed as special cautions listed during the approval process in Japan and the corresponding postmarketing safety studies were reviewed.
Result: Both countries have many safety concerns in common, however, in Japan, ongoing studies are only conventional studies, such as post-marketing surveillance studies or all-cases studies, while the U. S. conducts studies to meet each individual requirement need. Ideal post-marketing safety study designs proposed by the task force, seemed beyond sponsors capabilities, particularly with regard to conduct studies with control group, and require involvement of academia external research organizations, or establishment of the national registry system for cancer and other major diseases.
Conclusion: In Japan, Risk Management Plan (RMP) will soon be implemented in 2013, and that is expected to secure patientsʼ safety by the scientific pharmacovigilance plan with the international standard. It is an urgent task to discuss what plan is feasible in Japan and how to make the corporation of industry-government-academia a reality. (Jpn J Pharmacoepidemiol 2012; 17 (1): 55-66)

Persistent fifth aortic arch has been thought to be rare but often relevant to systemic circulation, however when it connects to the pulmonary artery (PA) in pulmonary atresia, it may be the sole arterial supply to the lung. This report describes a case of rare arch anomaly including right aortic arch (RAA), PA sling in conjunction with persistent left fifth aortic arch (PLFAA) and left subclavian artery arising from the left fourth arch. The tetralogy of Fallot, pulmonary atresia, and total anomalous of pulmonary venous connection (cardiac) were also diagnosed. A neonate was referred to our hospital for surgical treatment of cardiac and extracardiac anomalies. Persistent fifth aortic arch connecting with pulmonary artery was initially thought to be patent ductus arteriosus (PDA), so prostaglandin E 1 administration was commenced. He underwent emergency colostomy for anal atresia. Subepiglottic tracheal stenosis was diagnosed at initiation of anesthesia. At age 1-month-old, he required systemic to pulmonary shunt and reimplantation of left pulmonary artery through a median sternotomy using extracorporeal circulation. At the operation the PDA was divided and oversewn, and the wall structure was the same as that of a normal artery. The left pulmonary artery behind trachea was dissected and we then cut away and reimplanted to pulmonary trunk. Tracheostomy was performed at the age of two months. With the technical development of diagnostic imaging, the morphological features of arch anomaly were clearly demonstrated, but some understanding of embryological aspects are still required for diagnosis.

Objective:
There have been a few reports on the specificity of the meridians and Acupuncture-points. In order to identify the specific effects of the meridians and Acupuncture-points, the functional relations between “the gallbladder Meridian and gallbladder” were investigated using the gallbladder's form as an index.
Materials and Methods:
Ten healthy male adult volunteers participated in the experiments in fasting conditions. The target organ was the gallbladder, and its form was measured with the ultrasonic diagnostic apparatus (Toshiba SSA-90A). The images of the gallbladder form were taken at the point when the major long axis of the cross-section of the gallbladder reached the peak. The cross-sectional area of the gallbladder was measured with the image analyzer. The measurement of the gallbladder form was conducted after 15 minutes lying on the back, taking images for 10 minutes before stimulation, for 30 minutes during and after stimulation, every two to five minutes. The acupuncture stimulation was given at the points of G34, G36, G37, G40 and G44 on the right side of the body. After getting the deqi, 1 minute of sparrow pecking needle technique and 1 minute of leaving needle technique were conducted three times. The effect of the G40 under the egg yolk loading were also investigated.
Results:
1) The stimulation of the G34, G36, G37, and G44 showed no effects on the gallbladder form. 2) The stimulation of the G40 caused the distension of the gallbladder form. 3) The stimulation of the G40 showed the suppressive effect on the contraction of the gallbladder due to the load of egg yolk.
As described above, the results of this study showed that there is an acupuncture-point on the gallbladder meridian to cause the distension of the gallbladder specifically. It suggests the existence of the specificity of acupuncture-point.