Striking advances in systemic therapy for unresectable advanced hepatocellular carcinoma (HCC) have improved the average prognosis of patients with HCC. As a result, the guidelines for the treatment of HCC have changed significantly. However, various issues have emerged in clinical practice. First, there is no established biomarker that can predict response to systemic therapy. Second, there is no established treatment regimen after primary systemic therapy, including combined immunotherapy. Third, there is no established treatment regimen for intermediate-stage HCC. These points make the current guidelines ambiguous. In this review, we present the Japanese guidelines for the diagnosis and treatment of HCC based on the latest evidence; introduce various efforts mainly in Japanese real-life practice to update these guidelines; and present our perspectives on future guidelines.

Methods: A total of 14 patients with unilateral radicular symptoms and five healthy subjects were subjected to simultaneous apparent T2 mapping and neurography with nerve-sheath signal increased with inked rest-tissue rapid acquisition of relaxation enhancement signaling (SHINKEI-Quant) using a 3-Tesla magnetic resonance imaging. The Visual Analog Scale (VAS) score for neck pain and upper arm pain was used to evaluate clinical symptoms. T2 relaxation times of the cervical dorsal root ganglia of the brachial plexus were measured bilaterally from C4 to C8 in patients with radicular symptoms and from C5 to C8 in healthy controls. The T2 ratio was calculated as the affected side to unaffected side. Results: When comparing nerve roots bilaterally at each spinal level, no significant differences in T2 relaxation times were found between patients and healthy subjects. However, T2 relaxation times of nerve roots in the patients with unilateral radicular symptoms were significantly prolonged on the involved side compared with the uninvolved side (p<0.05). The VAS score for upper arm pain was not significantly correlated with the T2 relaxation times, but was positively correlated with the T2 ratio. Conclusions In patients with cervical radiculopathy, the SHINKEI-Quant technique can be used to quantitatively evaluate the compressed cervical nerve roots. The VAS score for upper arm pain was positively correlated with the T2 ratio. This suggests that the SHINKEI-Quant is a potential tool for the diagnosis of cervical nerve entrapment.

A retrospective observational study was performed.

Purpose: In this multicenter retrospective observational study, we examined the early effects of romosozumab in patients with severe osteoporosis in terms of time-course changes in bone metabolism marker, improvement in bone density, and adverse effects. Materials and Methods: Patients with severe osteoporosis were included. We investigated the progress of TRACP 5b and P1NP before and 1–2 months after the administration of romosozumab. We also investigated the bone density of lumbar spine, femoral neck, and the entire femur, measured by the DXA method, before and 5–7 months after the administration of romosozumab. Results: A total of 70 patients (7 males and 63 females, age 75.0±3.6 years) participated in this study. Significant improvements in TRACP 5b and P1NP levels were observed before and 1–2 months after romosozumab administration. The average bone density of lumbar spine, femoral neck, and the entire femur were measured before and 5–7 months after romosozumab administration;and a significant increase only observed in the lumbar spine. Conclusion Consistent with the findings of previous clinical studies, romosozumab has both bone formation-enhancing and bone resorption effects (dual effect). In addition, romosozumab also demonstrated improvement in bone density from the early phase after the administration, though the result was only seen in the lumbar spine.

Purpose: In this multicenter retrospective observational study, we examined the early effects of romosozumab in patients with severe osteoporosis in terms of time-course changes in bone metabolism marker, improvement in bone density, and adverse effects. Materials and Methods: Patients with severe osteoporosis were included. We investigated the progress of TRACP 5b and P1NP before and 1–2 months after the administration of romosozumab. We also investigated the bone density of lumbar spine, femoral neck, and the entire femur, measured by the DXA method, before and 5–7 months after the administration of romosozumab. Results: A total of 70 patients (7 males and 63 females, age 75.0±3.6 years) participated in this study. Significant improvements in TRACP 5b and P1NP levels were observed before and 1–2 months after romosozumab administration. The average bone density of lumbar spine, femoral neck, and the entire femur were measured before and 5–7 months after romosozumab administration;and a significant increase only observed in the lumbar spine. Conclusion Consistent with the findings of previous clinical studies, romosozumab has both bone formation-enhancing and bone resorption effects (dual effect). In addition, romosozumab also demonstrated improvement in bone density from the early phase after the administration, though the result was only seen in the lumbar spine.

A retrospective observational study was performed.

Objectives: “Adverse Drug Reaction Relief System” (hereinafter called the Relief System) has been established to provide prompt relief to patients experiencing health damage caused by adverse drug reactions. Since 2018, the Relief System has required community pharmacies that acquire additional points as local support system to actively report adverse drug reactions. Here, we investigated the recognition and utilization of the relief system among community pharmacists.Method: A questionnaire survey was conducted among community pharmacists between August 1 and September 30, 2019.Results: The survey achieved a response rate of 58.1%. The recognition rates of the relief system and Pharmaceuticals and Medical Devices Agency (PMDA) as its application destination were 98.9 and 74.5%, respectively. Of the community pharmacists, 2.6% had experience in utilizing the relief system; and 8.8% did not want to recommend the utilization of the relief system for patients mainly because of the “low recognition of the system” and “the complicated and troublesome preparation of the necessary documents such as medical certificates.” The community pharmacists who acquire additional points as local support system, compared with those who do not, achieved significantly higher rates in two items, including that for preparation of the documented procedures pertaining to adverse drug reactions.Conclusion: Despite the high recognition of the relief system among community pharmacists, the percentage of pharmacists with experience in actually utilizing the relief system and applying to the PMDA was low. One reason that the use of the relief system was not widespread was the low recognition particularly of the destination and procedures of reports on adverse drug reactions. In the future, educational campaigns to improve pharmacists’ comprehension of the relief system will be needed. Moreover, pharmacists must play a central role in enhancing the recognition of the public relief system and promoting medical safety.

Objective: In this study, we surveyed the attitudes of community pharmacists regarding oral antidiabetic drugs that need to be continuously administered, focusing especially on recently available oral‐combination antidiabetic drugs, in terms of their positioning and medication adherence.　In addition, we identified relevant problems from the survey results and discussed the proper use of the combination drugs.Methods: We conducted a questionnaire‐based survey on health insurance‐covered dispensing pharmacies belonging to Kanazawa, Koga, Takasaki, Hitachi, and Hitachinaka Pharmaceutical Associations via fax or post from September 1, 2017 to November 30, 2017.Results: The overall response rate to the survey was 29.8%.　Although combination drugs were considered useful in terms of improved motivation to take medication, i.e., medication adherence, there were also opinions claiming that combination drugs are not particularly useful due to the following reasons: there are problems in discarding residual drugs, they are less economical than individual drugs, it is difficult to ingest tablets of combination drugs because of their large size, it is difficult to adjust doses of combination drugs, and medication adherence does not change because of concomitant drug use.Conclusion: Based on the results there was the opinion that a combination oral diabetes drug improves medication adherence but problems such as the generation of leftover unused drugs due to switching and an increase in the risk of overuse when taking medication was pointed out.　It is necessary for pharmacists to give advice in recognition of the risks with each active ingredient of the oral diabetes combination drug and to continuously monitor any development of side effects.　Furthermore, as with other diabetes remedies, pharmacists need to advise regarding the patient's lifestyle as well as monitor laboratory test results such as kidney function.　The patient's swallowing ability is also an important consideration at the time of medication instruction.

While the session-RPE (rating of perceived exertion) method can quantify training volume in athletes, this method is not able to evaluate energy expenditure (EE) during a training session. We developed an RPE-based activity record for assessing EE during athletic training, and we compared its results to those obtained using the flex-heart rate (flex-HR) method. The EE of nine female collegiate endurance runners was assessed by the RPE-based activity record and flex-HR methods during eight days in the normal training season. Subjects were asked to record their RPE in the record at 5-minute intervals, and to wear a HR monitor during training. All subjects also participated in an incremental treadmill exercise test, which was used to determine their RPE-EE and HR-EE regression equations. Although the RPE-based activity record significantly overestimated EE (RPE-activity record, 572 kcal/session; flex-HR method, 499 kcal/session; p = 0.031), it had high validity relative to the flex-HR method (intra-class correlation coefficient, 0.891; 95% confidence interval, 0.845–0.923) and there were no systematic errors in EE estimation between the two methods. Therefore, the RPE-based activity record can be used to assess EE during training in female runners. However, RPE-based activity record might overestimate EE for athletes who have more intermittent activities during training than endurance runners, because RPE takes more time for returning to the resting level than HR when the intensity of activity declines. Further research is needed to verify the validity of the RPE-based activity record for assessing EE during other sporting activities or measurement conditions, and to identify the factors affecting the degree of estimation error associated with this method.