Background: Dexmedetomidine (DEX) is an α₂-adrenergic agonist widely used for intravenous sedation. Its pharmacological properties suggest autonomic modulatory effects; however, these remain insufficiently characterized during operative procedures. This pilot study compared autonomic responses to surgical stress of DEX and propofol (PPF) during third molar extraction using the Analgesia Nociception Index (ANI), a heart rate variability-derived marker of autonomic balance. Methods Adults aged ≥18 years undergoing extraction of mandibular third molars under intravenous sedation were prospectively enrolled. Sedation was maintained with either DEX or PPF infusion following a small pre-induction dose of midazolam. ANI was continuously recorded using a High-Frequency Variability Index module, with a 240-s moving average considered equivalent to ANI. The primary outcome was the minimum ANI value within each predefined 5-min intraoperative interval; percent change from baseline (%Δ

Background: The COVID-19 pandemic disrupted healthcare delivery worldwide, including dental services. In Japan, the burden and age-specific patterns of dental anesthesia use have not been quantified. We aimed to describe national trends in dental sedation and general anesthesia (GA) in Japan from fiscal year (FY) 2019 (pre-pandemic baseline) through FY 2023 using aggregated claim-level data from the National Database Open Data Japan and interpret these trends in the context of COVID-19-related healthcare constraints. We compared the age distributions of patients who underwent GA in dentistry and medicine. Methods: This analysis used aggregated claim counts from the National Database Open Data (FY 2019–FY 2023). Sedation and GA categories were defined using reimbursement codes: inhalation sedation (K002), intravenous sedation interpreted as conscious or moderate sedation (K003), intravenous anesthesia interpreted as deep sedation (L001–2), and GA (L008). Outcomes were annual claim counts, relative indices standardized to FY 2019 (=100), and age-stratified distributions in 5-year groups (0–4 years to ≥90 years). Age distributions for GA were visualized as mirrored pyramids in dentistry and medicine. No inferential tests were performed. Results: Inhalation sedation increased by approximately 7% in FY 2023. Intravenous sedation increased substantially by 68%. Intravenous anesthesia declined sharply in FY 2020, the first pandemic year, and then plateaued. Dental GA decreased in FY 2020, recovered, and expanded to 110,000 claims by FY 2023 (relative index: 122.3).Dental GA showed a bimodal age distribution (peaking at 5–9 years and 15–29 years), whereas medical GA were concentrated at 70–85 years, indicating distinct modality- and sector-specific demand structures. Conclusion Using claims tabulations spanning the pre-pandemic, pandemic, and “with-COVID” phases, we found heterogeneous trajectories in dental sedation and GA in Japan, characterized by robust growth in conscious or moderate sedation and recovery and expansion of dental GA after an initial 2020 decline. The divergent GA age distributions between dentistry and medicine underscore fundamentally different demand profiles.Interpreted within the context of COVID-19, these modality- and age-specific patterns highlight the adaptive and resilient responses of Japan’s dental anesthesia services under pandemic-related constraints and provide a foundation for future policy and workforce planning.

BACKGROUND/AIMS: Although the risk of bleeding after endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is low, the safety of EUS-FNA in patients prescribed antithrom-botic agents is unclear. Therefore, this study evaluated the incidence of bleeding after EUS-FNA in those patients. METHODS: Between September 2012 and September 2015, patients who were prescribed antithrombotic agents underwent EUS-FNA at 13 institutions in Japan were prospectively enrolled in the study. The antithrombotic agents were managed according to the guidelines of the Japanese Gastrointestinal Endoscopy Society. The rate of bleeding events, thromboembolic events and other complications within 2 weeks after EUS-FNA were analyzed. RESULTS: Of the 2,629 patients who underwent EUS-FNA during the study period, 85 (62 males; median age, 74 years) patients were included in this stduy. Two patients (2.4%; 95% confidence interval [CI], 0.6% to 8.3%) experienced bleeding events. One patient required surgical intervention for hemothorax 5 hours after EUS-FNA, and the other experienced melena 8 days after EUS-FNA and required red blood cell transfusions. No thromboembolic events occurred (0%; 95% CI, 0.0% to 4.4%). Three patients (3.5%; 95% CI, 1.2% to 10.0%) experienced peri-puncture abscess formation. CONCLUSIONS: The rate of bleeding after EUS-FNA in patients prescribed antithrombotic agents might be considerable.
Abscess ; Asian Continental Ancestry Group ; Endoscopic Ultrasound-Guided Fine Needle Aspiration* ; Endoscopy, Gastrointestinal ; Erythrocyte Transfusion ; Fibrinolytic Agents* ; Hemorrhage* ; Hemothorax ; Humans ; Incidence ; Japan ; Male ; Melena ; Prospective Studies*

Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) are essential for diagnosing and treating pancreatobiliary diseases. Single-session EUS and ERCP are considered to be essential in reducing the duration of hospital stays; however, complications are a primary concern. The aim of this study was to evaluate the safety and efficacy of single-session EUS and ERCP. Sixty-eight patients underwent single-session EUS and ERCP at a tertiary referral center between June 2008 and December 2012. We retrospectively reviewed patient data from a prospectively maintained EUS-ERCP database and evaluated the procedural characteristics and complications. Thirty-eight patients (56%) underwent diagnostic EUS, and 30 patients (44%) underwent EUS fine-needle aspiration, which had an overall accuracy of 100%. Sixty patients (89%) underwent therapeutic ERCP, whereas the remaining eight procedures were diagnostic. Thirteen patients underwent biliary stone extraction, and 48 underwent biliary drainage. The median total procedural time was 75 minutes. Complications were observed in seven patients (10%). Six complications were post-ERCP pancreatitis, which were resolved using conservative management. One patient developed Mallory-Weiss syndrome, which required endoscopic hemostasis. No sedation-related cardiopulmonary complications were observed. Single-session EUS and ERCP provided accurate diagnosis and effective management with a minimal complication rate.
Aged ; Biliary Tract Diseases/*diagnosis ; Cholangiopancreatography, Endoscopic Retrograde/*methods ; Endosonography/*methods ; Female ; Humans ; Male ; Middle Aged ; Pancreatic Diseases/*diagnosis ; Patient Safety ; Prospective Studies ; Retrospective Studies

Introduction: There has been no case report in which hyperpigmentation developed on the skin area where a transdermal fentanyl patch was applied in a patient. Case report: A 43-year-old man with recurrence of postoperative rectal cancer was treated by cetuximab plus irinotecan and panitumumab plus FOLFIRI. For cancer pain, transdermal fentanyl patch (Fentos®) was administered, and radiation from behind was performed. Hyperpigmentation then appeared on the chest and the abdominal skin sites where the patches were applied. The hyperpigmentation nearly disappeared four months after the fentanyl patch was discontinued. Discussion: The cause of the pigmentation was possibly due to post inflammatory hyperpigmentation secondary to contact dermatitis. It was desirable to conduct patch test and skin biopsy for making an accurate diagnosis. Conclusion: We should pay a careful attention to hyperpigmentation of the skin where a transdermal fentanyl patch is applied.

Object: Gagome kombu (Kjellmaniella cracciforia) is the edible brown seaweed and contains fucoidan, a sulfated polysaccharide, abundantly. Bunashimeji (Hypsizigus marmoreus) is the popular Japanese mushrooms and contains polyterpenes as the bitter substance. Previously, we investigated the bioactive functions (e.g. anti-tumor action) and the safety of fucoidan from Gagome kombu (GKF) and the extract from Bunashimeji (KTE: Kinoko terpene extract). In this study, we evaluate the influence of GKF and KTE on hepatic cytochrome P450 (CYP).
Methods: Male SD rats were divided into three groups (n = 5). 2,000 mg/kg of GKF and KTE were given orally once daily for 4 days.
Result: There were no difference in activities and mRNA expressions of hepatic CYPs (CYP2C11, CYP2D, CYP2E1 and CYP3A1) among all groups.
Conclusion: These results indicated GKF and KTE did not influence the rat hepatic CYPs.

Objective: “Ashitaba” (Angelica keiskei) is a traditional vegetable unique to Japan. Ashitaba contains an abundance of vitamins, dietary fiber and polyphenols such as chalcones. We previously reported anti-diabetic behavior of chalcones from Ashitaba. In this study, we evaluated the efficacy and safety of Ashitaba on patients and candidates with MetS.
Methods: Nine adult subjects defined as patients and candidates with MetS ingested Ashitaba green juice (6.2 g/day of granulated powder containing 12.3 mg chalcones) for 8 weeks. For evaluation of efficacy, abdominal fat area, body weight, body fat and blood parameters were measured. For evaluation of safety, blood chemistry analysis, hematological analysis and urinalysis were conducted.
Result: Ingestion of Ashitaba green juice for 8 weeks significantly decreased visceral fat area, body weight, BMI and body fat, respectively. There were no adverse clinical changes in blood analysis and urinary analysis, and no serious symptom was observed.
Conclusion: These results indicate that it is possible that Ashitaba is a useful and safe foodstuff for the prevention of MetS.

We evaluated the safety of Ashitaba (Angelica keiskei) in bacterial reverse mutation test as well as single and 13-weeks oral toxicity tests. In the bacterial reverse mutation test, ethanol extract of Ashitaba had no reverse mutation inducing activity on five bacterial strains with or without S9 metabolic activation. In the single oral toxicity test, Ashitaba powder (3,500 mg/kg/day) showed no adverse effects in male and female SD rats. In the 13-week repeated oral toxicity test, Ashitaba powder (875 and 1,750 mg/kg/day) showed no adverse effects on body weight, food consumption, blood biochemistry, hematology, urinalysis, ophthalmoscopy, organ weight and histopathology in male and female SD rats. These results indicate that Ashitaba is very safe foodstuff under the conditions of this study.

Objective: “Ashitaba” (Angelica keiskei) is a traditional vegetable peculiar to Japan. Ashitaba contains vitamins, dietary fiber and polyphenols such as chalcones abundantly. We previously reported anti-diabetic action of Ashitaba in an animal model as well as in diabetics. In this study, we evaluated the safety of Ashitaba green juice in healthy and borderline mildly diabetic subjects.
Methods: Japanese adult subjects (n = 24) ingested Ashitaba green juice (31.5 g granulated powder) for 4 weeks. For evaluation of safety, blood chemistry analysis, hematological analysis and urinalysis were conducted.
Result: On excessive ingestion of Ashitaba green juice for 4 weeks, there were no adverse clinical changes in blood analysis and urinary analysis and no serious symptom was observed.
Conclusion: These results indicate that excessive ingestion of Ashitaba green juice is safe in healthy and borderline mildly diabetic subjects.