Objective: This retrospective study was conducted to investigate whether medical students have ever bandaged patients' limbs, whether they feel confident in their ability to bandage, and whether their bandaging skills are adequate.Methods: The study included consecutive fifth-year medical students who had not been taught bandaging knowledge and skills. In total, 232 students (163 men, 69 women) participated in the study. Prior to the practical session, the students' experiences and confidence in bandaging were assessed. During the practical, an evaluator assessed the students' bandaging skills, determining the correct application of bandages and assigned a numerical score. Correlations were analyzed using the Chi-square test.Results: Of the medical students in this study, 60% had not bandaged a limb by their fifth year, and 91% lacked confidence in their bandaging ability. Only 32% of students could correctly apply a bandage with a perfect score. No significant relationships were identified between experience and bandaging skill (P = 0.64) or confidence and bandaging skill (P = 0.36).Conclusions: Bandages must be applied perfectly to prevent loosening and contamination of the wound. Nevertheless, most medical students had not bandaged a limb, lacked confidence in their bandaging abilities, and were unable to correctly apply a bandage. It is imperative that medical educators teach bandaging skills to medical students and provide ample opportunities for practice.

Neonatal Marfan syndrome is the most severe form of Marfan syndrome usually showing critical cardio-respiratory symptoms from the neonatal period or early infancy. We report a boy with this syndrome who presented with heart failure at 3 months of age and was referred to our department at 6 months old after intense medical treatment. He had enophthalmos, funnel chest, arachnodactyly, and Steinberg's thumb sign, but had no family history of Marfan syndrome or other cardiac diseases. Left ventricular dilatation, severe mitral regurgitation and moderate tricuspid regurgitation were noted on echocardiography. Mitral valvuloplasty and tricuspid annuloplasty were performed, and the regurgitation improved to trivial and mild level, respectively. However, rapid exacerbation of mitral regurgitation occurred, and the patient fell into circulatory collapse which needed circulatory support with extracorporeal membrane oxygenator (ECMO) on 18th postoperative day. In the emergency operation, the previous surgical procedures on the mitral valve were intact and we thought that rapid progression of the mitral annular dilatation and valve expansion to be the cause of exacerbation. Mitral valve replacement (Regent® 21 mm aortic) was performed, and the cardiac function improved, but ECMO was still needed because of the depressed respiratory function. Furthermore, tricuspid regurgitation due to annular dilatation and valve expansion was aggravated rapidly which needed tricuspid valve replacement (ATS® 20 mm mitral) 9 days after the mitral valve replacement. ECMO was ceased on the 37th day and the patient was extubated on 71st day. He was discharged from the hospital 5 months after the first operation. One year has passed after discharge, and he is doing well with anticoagulation. In the treatment of neonatal Marfan syndrome, surgical procedure for valve repair is still controversial and it should be remembered that rapid exacerbation of the atrioventricular valve can occur even after satisfactory valve repair and there should be no hesitation regarding surgical intervention when needed.

Objective: In our previous study, we revealed that articles on "dangerous drugs" in weekly magazines are inadequate and incomplete with respect to scientific validity, and that there may be many aspects that need to be improved. Next, the extent to which medical professionals, including doctors, pharmacists, and nurses, received consultations by patients owing to such media reports and what countermeasures are implemented requires clarification. In the present study, as a first step, we performed a questionnaire survey of community pharmacists to clarify the occurrence of such consultations.Methods: A questionnaire survey was conducted among 698 community pharmacists. The survey was conducted over 10 days from December 8 to 17, 2021.Results: Out of the 698 community pharmacists, 545 responded (response rate: 78.1%). Of these, 323 (59.3%) had experienced consultations from patients owing to media reports on the dangers of drugs. Of the 323 respondents, 215 (66.6%) had experienced these consultations less than five times. In contrast, 83 respondents (25.7%) reported more than 10 such consultations. Of the 545 respondents, 190 (34.9%) responded that they routinely perform measures to deal with media reports on the dangers of drugs. The most common routine measure was the "regular checking of various media sources (including preparation of responses when receiving consultation requests)."Conclusion: Our results indicated that more than half of the community pharmacists had experienced receiving consultations from patients, although only approximately 30% were adopting routine measures. This suggests that community pharmacists have been affected to some extent by these media reports, and that further countermeasures need to be implemented.

BACKGROUND: Research has indicated that early postoperative step counts are below the recommended levels for health-enhancing physical activity after total knee arthroplasty (TKA). This study aimed to evaluate the effects of preoperative individual characteristics, pain, physical function, and psychological factors on early postoperative physical activity, as measured by step counts, in 137 patients scheduled for TKA. METHODS: Patients were preoperatively assessed for individual characteristics (age, sex, body mass index, employment status, smoking and drinking habits, long-term care insurance), pain, range of motion, muscle strength, timed 10-m walk test performance, pain catastrophizing scale (PCS) scores (rumination, helplessness, and magnification), and pain self-efficacy. The daily step count was analyzed 4 weeks postoperatively. Multivariate regression analysis was performed to analyze the relationships between postoperative step counts and individual characteristics, pain, physical function, and psychological factors. RESULTS: Step counts were significantly influenced by preoperative PCS magnification scores (β= -0.31, p= 0.01) and the category of long-term care insurance (β= -0.24, p= 0.02). CONCLUSIONS Preoperative evaluation of the long-term care insurance category and PCS magnification score may aid in predicting early postoperative step counts in patients receiving TKA, which may, in turn, improve clinical management during the early stages of treatment.

Background: and Purpose To assess the long-term outcomes of intracranial dural arteriovenous fistula (DAVF) treated with stereotactic radiosurgery (SRS) alone or embolization and SRS (Emb-SRS) and to develop a grading system for predicting DAVF obliteration. Methods: This multi-institutional retrospective study included 200 patients with DAVF treated with SRS or Emb-SRS. We investigated the long-term obliteration rate and obliteration-associated factors. We developed a new grading system to estimate the obliteration rate. Additionally, we compared the outcomes of SRS and Emb-SRS by using propensity score matching. Results: The 3- and 4-year obliteration rates were 66.3% and 78.8%, respectively. The post-SRS hemorrhage rate was 2%. In the matched cohort, the SRS and Emb-SRS groups did not differ in the rates of obliteration (P=0.54) or post-SRS hemorrhage (P=0.50). In multivariable analysis, DAVF location and cortical venous reflux (CVR) were independently associated with obliteration. The new grading system assigned 2, 1, and 0 points to DAVFs in the anterior skull base or middle fossa, DAVFs with CVR or DAVFs in the superior sagittal sinus or tentorium, and DAVFs without these factors, respectively. Using the total points, patients were stratified into the highest (0 points), intermediate (1 point), or lowest (≥2 points) obliteration rate groups that exhibited 4-year obliteration rates of 94.4%, 71.3%, and 60.4%, respectively (P<0.01). Conclusions SRS-based therapy achieved DAVF obliteration in more than three-quarters of the patients at 4 years of age. Our grading system can stratify the obliteration rate and may guide physicians in treatment selection.

The patient was a 73-year-old man. He had sustained a spinal cord injury in a work-related accident at 40 years of age and was living with lower body paralysis. He had defecation disorder due to poor intestinal peristalsis of the sigmoid colon. Colostomy was indicated because the defecation disorder had worsened to the extent that hospital management was required. We selected a laparoscopic approach for two reasons. First, at the time of the accident, he had undergone thoracotomy and laparotomy to treat diaphragm injury and we expected that adhesions would need to be removed in the abdominal cavity. Second, patients with spinal cord injury are prone to poor bowel peristalsis, and minimally invasive surgery should be used to prevent postoperative paralytic ileus. The operation was performed with three ports. Adhesions of the transverse colon, omentum, and abdominal wall were peeled off, the transverse colon was mobilized, and a transverse colostomy was created in the upper right abdomen. The postoperative course was favorable, and he resumed eating on postoperative day 2. Laparoscopic colostomy for patients with spinal cord injury and defecation disorder can be a safe and effective technique for improving quality of life.

Patient 1 was a 73-year-old woman with chief complaints of abdominal pain and prolapse of bowel through the anus. About 10 cm of the intestine had prolapsed through the anus, and a mass was observed at the invasive front. Computed tomography (CT) revealed the classic target sign of an intussusceptum inside an intussuscipiens, where the sigmoid colon had intussuscepted into the rectum. Patient 2 was a 92-year-old woman who presented with a chief complaint of melena. About 5 cm of the intestine had prolapsed through the anus, and a mass was observed at the invasive front. CT showed the classic target sign in the rectum. Based on physical examination and CT findings, both cases were diagnosed as intussusception caused by progression of colorectal cancer. Manipulative reduction was attempted before surgery, but neither intussusception could be reduced and thus Hartmann’s operation was performed for both patients. Patient 1 had an uneventful postoperative course and was discharged on hospital day 36. Patient 2 developed prolonged paralytic ileus due to unsuccessful mobilization and was discharged on hospital day 80. Abdominoperineal resection is required for irreducible prolapse of intussusception through the anus due to colorectal cancer, and this invasive procedure can cause complications. Many patients with this condition are elderly adults with weak pelvic supporting tissue, and thus treatment suited to each individual patient must be selected.

Retrograde type A aortic dissection (RTAD) following thoracic endovascular aortic repair (TEVAR) is a lethal complication. A 54-year-old woman with bovine aortic arch presented with dilatation of the descending aorta due to chronic type B aortic dissection. She underwent TEVAR in zone 2 for closure of the entry site just below the origin of the left subclavian artery. On the day after TEAVR, she showed right hemiparesis, and was diagnosed with cerebral infarction on MRI and RTAD on CT. She underwent an emergent operation. The entry was at the proximal end of the bovine trunk, where the edge of the bare stent stuck out. We performed partial arch replacement with entry resection. Her postoperative course was uneventful. She was transferred to another hospital for rehabilitation 37 days after the surgery.

A 42 year-old woman with Marfan syndrome, who had replacement of the ascending aorta for acute aortic dissection several years ago, was found to have distal aortic arch aneurysm. The aneurysm had small entries at cervical arterial branches and large re-entry at the left external iliac artery. It was necessary to perform two-staged operation Bentall procedure with total arch replacement and abdominal aortic replacement with re-entry closure. It was usually performed with a primary entry closure for chronic aortic dissection, but massive invasion was expected. We performed catheter angiography for entry and re-entry, and decided to perform preceding re-entry closure. First, we underwent replacement of the abdominal aorta, and then successfully performed the Bentall procedure with total aortic arch replacement. The catheter angiography was useful for decision-making for medical treatment.

Objective: To evaluate the potential of local mosquitoes to act as vectors for dengue transmission in Japan.
Methods: Serotype 2 ThNH28/93 was used to test the dengue susceptibility profiles of Aedes flavopictus miyarai (Ae. f. miyarai), Aedes galloisi (Ae. galloisi) and Aedes albopictus (Ae. albopictus), which were collected in Japan. We used Aedes aegypti from Thailand as a positive control. The mosquitoes were infected with the virus intrathoracically or orally. At 10 or 14 days post infection, the mosquitoes were dissected and total RNA was extracted from their abdomens, thoraxes, heads and legs. Mosquito susceptibility to dengue virus was evaluated using RT-PCR with dengue virus-specific primers. Differences in the infection and mortality rates of the different mosquito species were tested using Fisher's exact probability test.
Results: The infection rates for dengue virus administered intrathoracically to Ae. f. miyarai, Ae. galloisi and Aedes aegypti mosquitoes were identical by RT-PCR on Day 10 post infection. All of the body parts we tested were RT-PCR-positive for dengue virus. For the orally admin-istered virus, the infection rates in the different body parts of the Ae. f. miyarai mosquitoes were slightly higher than those of Ae. albopictus mosquitoes, but were similar to the control mosquitoes (P>0.05). The mortality rates for Ae. f. miyarai and Ae. albopictus mosquitoes were similar (P=0.19). Our data indicated that dengue virus was able to replicate and disseminate to secondary infection sites in all of the four mosquito species (Japanese and Thai).
Conclusions: Ae. albopictus is a well-known candidate for dengue transmission in Japan. However, our data suggest that Ae. f. miyarai from Ishigaki Island (near Okinawa Island) and Ae. galloisi from Hokkaido (Northern Japan) should also be regarded as potential vectors for dengue transmission in these regions. Further studies on these mosquitoes should be conducted.