Objective: Therapeutic antibodies have few varieties of side effects due to their high specificity; however, many therapeutic antibodies have serious side effects. A thorough understanding of the side effects is crucial for early recognition and optimal management. To facilitate the understanding of the side effects of therapeutic antibodies, this study attempted to classify therapeutic antibodies based on their side effects using principal component analysis (PCA) and cluster analysis. Method: We collected data on the serious side effects of therapeutic antibodies from package inserts and created a therapeutic antibody-side effect matrix, with therapeutic antibodies as indices and side effects as columns. PCA was performed on the therapeutic antibody-side effect matrix, and hierarchical cluster analysis was performed using principal components. Results: The therapeutic antibodies were classified into four clusters. Cluster 1 included immune checkpoint inhibitors, and featured type 1 diabetes, thyroid disorder, and myasthenia gravis. Cluster 2 included antibodies that inhibit the vascular endothelial growth factor pathway, and featured impaired wound healing, nephrotic syndrome, and thrombosis. Cluster 3 included anti-epidermal growth factor receptor antibodies, and featured diarrhea, hypomagnesemia, and skin disorders. Cluster 4 included other therapeutic antibodies, and featured infection, bone marrow suppression, and hypersensitivity. Conclusion: Therapeutic antibodies can be classified based on their side effects. The results of this study make it easier to understand the side effects of therapeutic antibodies with complex profiles. A better understanding facilitates early detection of side effects and enables high-quality management of side effects.

BACKGROUND: Studies on the adverse effects of Asian dust (AD) on respiratory function in children are scarce. The objective of this study was to examine the association between AD and respiratory function by measuring peak expiratory flow rates (PEFRs) in asthmatic children. METHODS: The study was carried out from March to May from 2014 through 2016. One hundred ten children with bronchial asthma were recruited from four hospitals in the Goto Islands and south Nagasaki area in Nagasaki prefecture. The parents were asked to record their children's PEFRs every morning/evening and clinical symptoms in an asthma diary. AD was assessed from light detection and ranging data, and a linear mixed-effects model was used to estimate the effects of AD on daily PEFR. Time-stratified case-crossover analyses were performed to examine the association between AD and asthma attacks defined by reduction levels in PEFR. RESULTS: AD was detected on 11 days in the Goto Islands, and on 23 days in the south Nagasaki area. After adjusting for age, sex, temperature, and daily oxidants, we found a consistent association between AD and a 1.1% to 1.7% decrease in PEFR in the mornings and a 0.7% to 1.3% decrease in the evenings at a lag of 0 to 5 days. AD was not associated with the number of asthma attacks, respiratory symptoms, or other symptoms at any lag days examined. CONCLUSIONS Exposure to AD was associated with reduced PEFR, although the effects were not large enough to induce clinically apparent symptoms, in clinically well-controlled asthmatic children.

Background/Aims: Three-dimensional (3D) flexible endoscopy, a new imaging modality that provides a stereoscopic view, can facilitate endoscopic hand suturing (EHS), a novel intraluminal suturing technique. This ex-vivo pilot study evaluated the usefulness of 3D endoscopy in EHS. Methods: Four endoscopists (two certified, two non-certified) performed EHS in six sessions on a soft resin pad. Each session involved five stitches, under alternating 3D and two-dimensional (2D) conditions. Suturing time (sec/session), changes in suturing time, and accuracy of suturing were compared between 2D and 3D conditions. Results: The mean suturing time was shorter in 3D than in 2D (9.8±3.4 min/session vs. 11.2±5.1 min/session) conditions and EHS was completed faster in 3D conditions, particularly by non-certified endoscopists. The suturing speed increased as the 3D sessions progressed. Error rates (failure to grasp the needle, failure to thread the needle, and puncture retrial) in the 3D condition were lower than those in the 2D condition, whereas there was no apparent difference in deviation distance. Conclusions 3D endoscopy may contribute to increasing the speed and accuracy of EHS in a short time period. Stereoscopic viewing during 3D endoscopy may help in efficient skill acquisition for EHS, particularly among novice endoscopists.

Objectives: To assess the perception of care and outcomes of end-of-life palliative care by bereaved family members to determine differences in care provided to patients with and without cancer. Methods: This cross-sectional, anonymous survey using a self-reporting questionnaire for bereaved family members was conducted online. Care was assessed using overall satisfaction score and the care evaluation scale (CES) and outcomes were assessed using good death inventory (GDI). Results: The present study included data from 118 patients with cancer and 299 patients without cancer (103, heart failure; 71, stroke; and 125, pneumonia). The overall satisfaction score was not significantly different between patients with and without cancer. Conversely, physical care score in the CES and autonomy score in the GDI were significantly lower in patients without cancer than in patients with cancer (p<0.05). Conclusion: The satisfaction with end-of-life care was comparable between the bereaved family members of patients without cancer and those of patients with cancer. However, results related to some items of CES and GDI suggest that some components of end-of-life care for patients without cancer might require attention. Not only treatment of the underlying disease but also relief of suffering is important to improve end-of-life care.

Objective: To clarify challenges and strategies to execute pharmaceutical care by community pharmacists and obtain pragmatic implications for further improvement. Design: Cross-sectional study.. Methods: We conducted a nationwide internet-based questionnaire survey about pharmaceutical care by the Japanese community pharmacists in June and July 2016. Using text data of 161 respondents, we investigated their challenges and strategies in implementing pharmaceutical care. The text data were reviewed and determined for categorization through stepwise process and reconciliation between reviewers. Results: Fourteen categories were retrieved and integrated into 4 domains (pharmacists, patients, other medical professionals, and environment) from 2 dimensions (challenges and strategies). In the challenge dimension (total n＝142), communication capability (n＝26), participation in medical team (n＝17), patients’ understanding of pharmacists’ work (n＝14), lack of timeand staff (n＝14),patient- and people-centered viewpoint (n＝13). Whilein thestrategy dimension (total n＝72), communication capability (n＝21),lack of patients’ medical information (n＝18), patient- and people-centered viewpoint (n＝11), lack of timeand staff (n＝9), and self development (n＝5). As strategies for the communication capability, attitude of acceptance and collaboration, brief explanation,utilization of visual aids, adoption of objective evaluation, various acquisition of patients’ information, active listening, and sharing patients’ information were retrieved as subcategories. The highest level of attention to communication capability implies that community pharmacists certainly recognize their expected responsibility described in the government document titled “Vision for patient-centered pharmacies”. Conclusion: Community pharmacists face many challenges but have some practical strategies. Although part of such challenges is not for pharmacists themselves but for patients, other medical professionals, or entire health system, improving essential skills of pharmacists may havepositiveinfluenceto theother challenges.

We have several choices against bleeding and obstruction in advanced gastric cancer patients such as surgical or endoscopic therapy. But we have few reports about palliative radiation. We conduct this study that we perform palliative radiation for unresectable advanced gastric cancer patients between April 2006 and March 2014 in single center. In the aim of the therapy, to stop gastric bleeding were 8, and to improve obstruction depend on gastric cancer were 4. Response rate of stop bleeding was 63％, and improve obstruction was 50％. Median duration of stop bleeding was 103 day, and improve obstruction was 52 day. Overall survival time was 567 day, survival time after the start of radiotherapy was 105days. Radiotherapy was limited in cases because onset time of response needed in comparison with surgical or endoscopic therapy. However, given minimally invasive therapy and a certain response, we can choice it so much more.

Background: Borderline resectable pancreatic adenocarcinoma (BR-PAC) is defined as locally advanced tumor of the pancreas without metastasis that is, although potentially resectable (R), at high risk for positive resection margin following surgery. The therapeutic strategy has remained unestablished because BR-PAC is biologically a heterogeneous subset in which the preoperative prognostic factors are undetermined. Recently, several prognostic factors related to systemic inflammation have been explored in various kinds of cancers: the combination of serum C-reactive protein (CRP) and albumin as the modified Glasgow prognostic factor; a combination of CRP and white blood cell count in the prognostic index; a combination of albumin and lymphocyte counts in Onodera’s prognostic nutritional index; the neutrophil-lymphocyte ratio (NLR); and the platelet-lymphocyte ratio (PLR). Although these prognostic factors have been explored in some small cohort studies of PAC patients, the results still remain controversial especially because PAC patients with diverse clinical stages were included in the cohorts. It has never been reported whether or not the systemic inflammatory response is validated as a predictive risk factor in cohorts of only advanced BR-PAC patients. Method: Between January 2003 and June 2012 at Kobe University Hospital, 136 consecutive pancreatic adenocarcinoma (PAC) patients who underwent surgical curative resection were retrospectively studied. Prior to surgery, the PAC patients were stratified into R- and BR-PAC patients according to the National Comprehensive Cancer Network guidelines. To evaluate the independent prognostic significance of NLR and PLR, univariate and multivariate Cox proportional-hazard models were applied. Results: The median survival in PAC patients with preoperative NLR > 3 (n=45) and NLR < 3 (n=91) was 17.5 months and 31.1 months, respectively (P=0.0037). However, the median survival in PAC patients with PLR > 225 (n=32) and PLR < 225 (n=104) was 21.8 months and 26.2 months, showing no significant difference in overall survival between the two groups (P=0.2526). The median survival in the R-PAC patients with NLR > 3 (n=38) and NLR < 3 (n=70) was 18.1 months and 33.1 months, respectively (P=0.0138). However, the median survival in the R-PAC patients with PLR > 225 (n=27) and PLR < 225 (n=81) was 24.1 months and 25.8 months, showing no significant difference in overall survival between the two groups (P=0.6533). The median survival in BR-PAC patients with preoperative NLR > 3 (n=7) and NLR < 3 (n=21) was 14.8 months and 27.2 months, respectively (P=0.0068). In addition, median survival in BR-PAC patients with preoperative PLR > 225 (n=5) and PLR < 225 (n=23) was 14.8 months and 26.2 months, respectively (P=0.0050). Preoperative NLR > 3 (HR=21.437, 95% CI=4.119-142.980; P=0.0002) and PLR > 225 (HR=30.993, 95% CI=3.844- 384.831; P=0.0009) were the only independent prognostic factors in BR-PAC patients. Conclusion: Preoperative NLR and PLR offer independent prognostic information regarding overall survival in BR-PAC patients following curative resection. The workup is only to obtain a blood sample of 3 mL from PAC patients immediately before treatment. In the near future, these factors associated with the systemic inflammatory response may have the potential to become criteria for BRPAC candidates to undergo neoadjuvant chemotherapy and/or neoadjuvant chemoradiation followed by surgical resection

Background: Borderline resectable pancreatic adenocarcinoma (BR-PAC) isdefined as locally advanced tumor of the pancreas without metastasis that is,although potentially resectable (R), at high risk for positive resection marginfollowing surgery. The therapeutic strategy has remained unestablished becauseBR-PAC is biologically a heterogeneous subset in which the preoperativeprognostic factors are undetermined. Recently, several prognostic factors relatedto systemic inflammation have been explored in various kinds of cancers: thecombination of serum C-reactive protein (CRP) and albumin as the modifiedGlasgow prognostic factor; a combination of CRP and white blood cell countin the prognostic index; a combination of albumin and lymphocyte counts inOnodera’s prognostic nutritional index; the neutrophil-lymphocyte ratio (NLR);and the platelet-lymphocyte ratio (PLR). Although these prognostic factors havebeen explored in some small cohort studies of PAC patients, the results still remaincontroversial especially because PAC patients with diverse clinical stages wereincluded in the cohorts. It has never been reported whether or not the systemicinflammatory response is validated as a predictive risk factor in cohorts of onlyadvanced BR-PAC patients.Method: Between January 2003 and June 2012 at Kobe University Hospital,136 consecutive pancreatic adenocarcinoma (PAC) patients who underwentsurgical curative resection were retrospectively studied. Prior to surgery, the PACpatients were stratified into R- and BR-PAC patients according to the NationalComprehensive Cancer Network guidelines. To evaluate the independentprognostic significance of NLR and PLR, univariate and multivariate Coxproportional-hazard models were applied.Results: The median survival in PAC patients with preoperative NLR > 3 (n=45)and NLR < 3 (n=91) was 17.5 months and 31.1 months, respectively (P=0.0037).However, the median survival in PAC patients with PLR > 225 (n=32) and PLR< 225 (n=104) was 21.8 months and 26.2 months, showing no significantdifference in overall survival between the two groups (P=0.2526). The mediansurvival in the R-PAC patients with NLR > 3 (n=38) and NLR < 3 (n=70) was 18.1months and 33.1 months, respectively (P=0.0138). However, the median survivalin the R-PAC patients with PLR > 225 (n=27) and PLR < 225 (n=81) was 24.1months and 25.8 months, showing no significant difference in overall survivalbetween the two groups (P=0.6533). The median survival in BR-PAC patientswith preoperative NLR > 3 (n=7) and NLR < 3 (n=21) was 14.8 months and 27.2months, respectively (P=0.0068). In addition, median survival in BR-PAC patientswith preoperative PLR > 225 (n=5) and PLR < 225 (n=23) was 14.8 months and26.2 months, respectively (P=0.0050). Preoperative NLR > 3 (HR=21.437, 95%CI=4.119-142.980; P=0.0002) and PLR > 225 (HR=30.993, 95% CI=3.844-384.831; P=0.0009) were the only independent prognostic factors in BR-PACpatients.Conclusion: Preoperative NLR and PLR offer independent prognostic informationregarding overall survival in BR-PAC patients following curative resection. Theworkup is only to obtain a blood sample of 3 mL from PAC patients immediatelybefore treatment. In the near future, these factors associated with the systemicinflammatory response may have the potential to become criteria for BRPACcandidates to undergo neoadjuvant chemotherapy and/or neoadjuvantchemoradiation followed by surgical resection

  On July 7, 2010, a 74-year-old man came to our hospital, complaining that he had a nagging pain in his chest that started the preceding day. After performing electrocardiography, blood tests and electrocardiography, we diagnosed the case as acute myocardial infarction. At first, it was thought that blood flow could be restored in due course of time, antiplatelet and anticoagulant agents were used. Intracardiac catheterization was not included in our initial treatment plan. Three days after the initiation of the treatment, the patient had pain in his left inguinocrural region. Computed tomography and magnetic resonance imaging reveled hematoma in his left iliopsoas muscle. We stopped administering antiplatelet and anticoagulant agents to him. But anemia progressed from Hb14.1g/dL to 9.8 g/dL, so blood transfusions had to be given. After that, the patient underwent a rest cure. With the passage of time, the pain and swelling of the left iliopsoas muscle went down. Regarding the cardiac condition, however, the pain in the chest did not abate even when he was taking a rest. The antiplatelet therapy was resumed, with one type of agent given at first and then with another type added. Examinations using a coronary CT and a cadiac catheter found 90% stenosis at the proximal left anterior descending coronary artery. So, a bare metal stent was placed in the near-closed artery. Ever since, there has been no recrudescence of chest pain and no recurrence of iliopsoas muscle hematoma. The extravascated blood mass seemed to be dissolved spontaneously.

This study aimed to clarify whether a regional palliative care intervention program, the OPTIM project, increased home hospice utilization, and explore the potential association between the home hospice utilization and the hospital staff's perceptions on home care. A questionnaire survey was conducted involving 154 physicians and 469 nurses. The rate of patients who made the transition to home-based care increased 967% in A Hospital, 295% in B Hospital, and 221% in C Hospital in 2010 compared to 2007, which was assumed to be 100. Staff of a hospital where many patients made the transition to home-based care were more likely to agree with the following statements concerning home care perspectives: “I started to consider that even cancer patients can be treated at home until the last moment of their life”, “I usually ask patients whether they wish to receive home-based care”, “We decided on coping strategies for sudden changes in the course of disease and a place to contact in advance”, and “I started to simplify treatment procedures, such as prescriptions during hospitalization for patients and their families to prepare for home-based care“.