Background: Poly (adenosine diphosphate)-ribose polymerase (PARP) inhibitors for tumors with homologous recombination deficiency (HRD), including pathogenic mutations in BRCA1/2, have been developed. Genomic analysis revealed that about 20% of uterine leiomyosarcoma (uLMS) have HRD, including 7.5%–10% of BRCA1/2 alterations and 4%–6% of carcinomas of the uterine corpus, and 2.5%–4% of the uterine cervix have alterations of BRCA1/2. Preclinical and clinical case reports suggest that PARP inhibitors may be effective against those targets. The Japanese Gynecologic Oncology Group (JGOG) is now planning to conduct a new investigator-initiated clinical trial, JGOG2052. Methods JGOG2052 is a single-arm, open-label, multi-center, phase 2 clinical trial to evaluate the efficacy and safety of niraparib monotherapy for a recurrent or persistent rare fraction of gynecologic malignancies with BRCA1/2 mutations except for ovarian cancers. We will independently consider the effect of niraparib for uLMS or other gynecologic malignancies with BRCA1/2 mutations (cohort A, C) and HRD positive uLMS without BRCA1/2 mutations (cohort B). Participants must have 1–3 lines of previous chemotherapy and at least one measurable lesion according to RECIST (v.1.1). Niraparib will be orally administered once a day until lesion exacerbation or unacceptable adverse events occur. Efficacy will be evaluated by imaging through an additional computed tomography scan every 8 weeks. Safety will be measured weekly in cycle 1 and every 4 weeks after cycle 2 by blood tests and physical examinations. The sample size is 16–20 in each of cohort A and B, and 31 in cohort C. Primary endpoint is the objective response rate.

We developed an education system utilizing virtual reality/augmented reality (VR/AR) technologies for clinical clerkships in emergency medicine. We used a spherical camera to record the scenes of emergency medical treatment, and then added subtitles/captions of clinical information onto the video data to help the learners’ understanding. Before watching the video, learners prepared with basic knowledge for the clinical situations to be addressed. By monitoring line of sight, instructors were able to estimate how far the students understood the situations and give appropriate feedback on the spot. These results suggest that an application of VR/AR technologies combined with preparatory learning materials and measurement of learners’ understanding in watching video provides an interactive and participatory educational context for knowledge acquisition in clinical clerkships. This system can be introduced at low cost and also can grow as a platform shared between teaching facilities.

An epidemiological study reported that low serum cholesterol is one of the causes of cerebral hemorrhage. Furthermore, differences in the Apoprotein E (ApoE) genotype influence the amount of low density lipoprotein in serum. The value of standardized mortality ratio (SMR) for cerebral hemorrhage or infarction in residents of Kikai island (KI) is higher or lower than 100, respectively. The aim of this educational activity is to assess whether our lectures on “prevention of stroke” ─(1) relationship between cholesterol and stroke, (2) test items involved in cholesterol of serum and role of lipoprotein, (3) relationship between gene and disease, and (4) prevention of disease by diet─were effective for junior high-school students (JHS) in KI. To be improve their understanding of lecture (3), we performed genetic analysis (for ApoE polymorphism) using DNA extracted from their hair roots. Although we also conducted lectures after the results of the analysis, the pretest (40.7%) and posttest (50.0%) indicated that lecture (3) had been difficult for JHS. The total scores for the posttests for second- and third-year JHS (72.5% and 80.3%, respectively) were significantly higher than those for the pretests for second- and third-year JHS (49.6% and 55.9%, respectively). However, for first-year JHS, the total scores for posttests (63.0%) and pretests (61.7%) were not significantly different. Based on these results, we concluded that our lectures facilitated a substantial understanding about the “prevention of stroke” among JHS and were educationally beneficial for second- and third-year JHS, in particular.

Objective: Consultation contents from medical consumers can become a useful information for medical workers.  However, report which investigated about them is limited.  In this study, we investigated the question contents from medical consumers with telephone.
Methods: Nineteen hundred records on the consultation from medical consumers with telephone from 2007 to 2011 were subject to this study.  Using appropriate keywords and check the records, corresponding cases were extracted.
Results: Resources of drug information which medical consumers used had various one such as the Internet, television, books, and newspapers.  However the medical consumers did not necessarily understand drug information correctly from the Internet and books.  This means that support by pharmacists was necessary in those cases.
Conclusion: We think that information sharing in the medical consumers and medical workers based on a good relationship is important for proper use of drugs.

An 81-year-old man underwent aortic valve replacement with a 21-mm Medtronic Mosaic porcine bioprosthesis for the treatment of bicuspid aortic valve stenosis. In addition to the appearance of chest discomfort on effort and a new diastolic murmur, echocardiography performed 2 years and 3 months after the surgery showed a high pressure gradient across the bioprosthetic valve and a reduction in the valve orifice area. Prosthetic valve dysfunction was diagnosed. During a repeat operation, 2 large tears on the left cusp and a subvalvular overgrown abundant pannus were observed, and the bioprosthetic valve was replaced with a 19-mm On-X mechanical heart valve. On analysis of the explant bioprosthesis, the right non-coronary stent post was bent outwards by approximately 9°, it compressed the left cusp by pulling the left right and left non-coronary stent posts closer together, thus altering the leaflet geometry and function. We speculated that pannus formation had resulted from turbulent blood flow caused by impaired or altered leaflet function. The 2 large tears appeared to be the result of contact with the bias cloth secondary to the stent distortion.

1) In problem-based learning (PBL) tutorials during the2nd year, general symptoms (fatigue, weight change, bleeding, fever, pain, and edema) were chosen as subjects.Changes in the students'way of thinking about how to learn were evaluated before and after PBL tutorials.
2) After tutorials students were significantly more likely to believe that their participation in tutorials was a more effective way of learning. The students'views after tutorials on listening to lectures differed between2006and2007.
3) We conclude that PBL tutorials affect medical students'views about learning.

Objective : To evaluate the effect of heat and steam generating sheets on osteoarthritis of the knee. Methods : Subjects with osteoarthritis of the knee (n=41) were randomized into 2 groups : a heat and steam generating sheet group or a heat generating sheet group. Functional impairment [Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Japan Orthopaedic Association score (JOA score)] in the index knee were measured at baseline and then again after 2 and 4 weeks of wear. Results : At both the 2 and 4 week patient evaluations, the heat and steam generating sheet group showed improved total WOMAC scores. Although the heat generating sheet groups' WOMAC scores were improved after 2 weeks, the difference between the 2 and 4 week evaluations was not statistically significant. As for individual WOMAC scores, patients in the heat and steam generating sheet group especially demonstrated a highly significant decrease in WOMAC stiffness score. In comparison, patients in the heat generating sheet group showed no improvement in WOMAC stiffness score. Gait ability improvement, as measured by JOA score, showed similar results for both groups. Conclusion : This study showed that using heat and steam generating sheets decreased pain and stiffness, and increased gait ability in patients with osteoarthritis of the knee.

An 80-year-old man was transferred to our hospital because of blunt traumatic aortic arch injury caused by a fall. Computed tomography (CT) revealed a pseudoaneurysm and mediastinal hematoma around the aortic arch, right hemothorax, left hemopneumothorax, lung contusion and spine fractures. His hemodynamic condition was stable but he required mechanical ventilation because of severe hypoxemia. Surgery was postponed until twelve days after the injury, when his lung function improved and active bleeding decreased. During surgery we found that the intimal disruption extended to half of the circumference of the aortic arch, and thus performed total arch replacement under deep hypothermic circulatory arrest and selective cerebral perfusion. The patient suffered respiratory failure and pneumonia postoperatively as well as multiple cerebral infarctions. He was referred to a rehabilitation center on postoperative day 130.

A 36-year-old woman was admitted because of dyspnea on exertion and palpitations, during follow-up for ventricular septal defect since age 5. Physical examination revealed a grade IV/VI ejection systolic murmur at the second left intercostal space. Echocardiogram failed to recognize an unruptured aneurysm of the sinus of Valsalva protruding into the right ventricle which was seen on right ventriculogram (type I of Konno). Surgical treatment was successfully performed. Right ventriculography was much more effective rather than echocardiography in this case.

Ventricular Septal Defect (VSD) is the most frequent cardiovascular anomaly. VSD causes pulmonary hypertension through stenotic changes in the pulmonary vasculature, and this progress depends on the size of defect and associated cardiovascular anomalies. Since surgical repair has been performed in childhood for patients without a tendency toward spontaneous closure of VSD, operations in elderly patients, especially those aged over 40, are rare. We report an elderly patient with VSD complicated with severe pulmonary hypertension who underwent surgical repair. A 66-year-old man was admitted to our hospital because of general fatigue, chest oppression and palpitations. The pulmonary to systemic pressure ratio was 0.66. The oxygen saturation stepped up at the right ventricle level. The pulmonary to systemic blood flow ratio was 2.9, shunt ratio was 71% and resistance ratio was 0.12. The VSD was 18mm in diameter at the perimembranous trabecula and was closed with a Dacron patch through a right atrium incision. The lung biopsy specimen revealed little occlusive pulmonary vascular disease, Grade I according to the Heath-Edwards criteria. The patient had an uneventful recovery.