Background/Aims: Intralesional steroid injections have been administered as prophylaxis for stenosis after esophageal endoscopic submucosal dissection. However, this method carries a risk of potential complications such as perforation because a fine needle is used to directly puncture the postoperative ulcer. We devised a new method of steroid intralesional infusion using a spray tube and evaluated its efficacy and safety. Methods: Intralesional steroid infusion using a spray tube was performed on 27 patients who underwent endoscopic submucosal dissection for superficial esophageal cancer with three-quarters or more of the lumen circumference resected. The presence or absence of stenosis, complications, and the number of endoscopic balloon dilations (EBDs) performed were evaluated after treatment. Results: Although stenosis was not observed in 22 of the 27 patients, five patients had stenosis and dysphagia requiring EBD. The stenosis in these five patients was relieved after four EBDs. No complications related to intralesional steroid infusion using the spray tube were observed. Conclusions Intralesional steroid infusion using a spray tube is a simple and safe technique that is adequately effective in preventing stenosis Clinical trial number (UMIN000037567).

The conventional crushing method for administration of drugs to patients with feeding tubes has been commonly used at the Hyogo College of Medicine College Hospital. Compared with this conventional method, the simple suspension method can reduce drug degradation due to light and moisture absorption as well as avoid drug loss and contamination. We conducted a workshop to introduce this method to pharmacists. We asked the participants to fill a questionnaire-based survey both before and after the workshop to determine the effects of the workshop on the change in the degree of awareness among participants about these methods. The awareness of participants about the simple suspension method was approximately 80% before the workshop. Approximately 60% of participants answered that they had questions about simple suspension method from individuals from other occupations, suggesting a high awareness of this method. After the workshop, approximately 98% of participants answered that they were “satisfied” or “slightly satisfied,” suggesting that they were in favor of introducing the suspension method. The results of text mining indicated a requirement for participants to consider incompatibilities and to educate the nursing department. Participants who actively considered the proposal of simple suspension method had an altered perception toward the introduction and utilization of this method. Therefore, this survey suggested that workshops could alter the perception and behavior of pharmacists about the methods of drug administration via feeding tube.

Methods: Sagittal spinopelvic alignment was evaluated in 110 subjects using radiographs of the whole spine. Parameters measured in this study included sagittal vertical axis (SVA), LL, sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). The distribution of sagittal plane modifier grade was evaluated according to the Scoliosis Research Society-Schwab classification of adult spinal deformity (ASD). Consequently, personal history related to LBP was obtained, and the association of pre- and postoperative LBP and spinopelvic alignment was investigated. Results: Preoperatively, 66% of all subjects showed LBP and mostly exhibited anteriorly shifted global imbalance associated with a decrease in LL and knee flexion contractures, and the subject who had severe flexion contracture of the knee joint showed more forwardly shifted global balance with backward PT and decrease in LL. After TKAs, the knee flexion contractures were eliminated in most cases, and one-third of subjects experienced decrease in LBP. However, SVA increased more and associated with slight decrease of PT and increase of SS. No significant differences were confirmed between pre- and postoperative values of LL and PI. In addition, there were no significant differences in postoperative values of spinopelvic parameters between subjects with and without relieved LBP. Conclusions Although one-third of subjects experienced decrease of LBP after TKAs, the sagittal global imbalance was not restored through the removal of knee flexion contracture.

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.

Introduction: This study reports on a case of SAPHO syndrome in a patient in the palliative care unit who had multiple bone metastases of an unknown primary carcinoma. Case: A 74 year old male presented with broken eleventh thoracic and third lumbar vertebrae. Magnetic resonance imaging (MRI) revealed multiple lesions, which were thought to be bone metastases of a carcinoma, in the thoracic and lumbar spine. Attempts to identify the location of the primary lesion were unsuccessful. Therefore, the differential diagnosis was multiple bone metastases of an unknown primary carcinoma. The patient was transferred to the palliative care unit. The patient’s condition remained largely unchanged for several years; therefore, a second set of clinical examinations was conducted. Computed tomography revealed sternocostoclavicular hyperostosis, and there was symmetric uptake on bone scintigraphy. Further MRI studies revealed that the spinal lesions were comparatively reduced, leading to a diagnosis of SAPHO syndrome. Discussion: SAPHO syndrome is a rare, benign disease that presents as a variety of osteoarticular disorders with specific dermatoses. SAPHO syndrome is difficult to diagnose; therefore, it is important to consider it as a differential diagnosis in patients with bone lesions.

BACKGROUND: Melanin is detectable in various sense organs including the skin in animals. It has been reported that melanin adsorbs toxic elements such as mercury, cadmium, and lead. In this study, we investigated the adsorption of molybdenum, which is widely recognized as a toxic element, by melanin. METHODS: Molybdenum level of the mouse skin was measured by inductively coupled plasma mass spectrometry. The pigmentation level of murine skin was digitalized as the L* value by using a reflectance spectrophotometer. An in vitro adsorption assay was performed to confirm the interaction between molybdenum and melanin. RESULTS: Our analysis of hairless mice with different levels of skin pigmentation showed that the level of molybdenum increased with an increase in the level of skin pigmentation (L* value). Moreover, our analysis by Spearman's correlation coefficient test showed a strong correlation (r = - 0.9441, p < 0.0001) between L* value and molybdenum level. Our cell-free experiment using the Langmuir isotherm provided evidence for the adsorption of molybdenum by melanin. The maximum adsorption capacity of 1 mg of synthetic melanin for molybdenum was 131 μg in theory. CONCLUSION Our in vivo and in vitro results showed a new aspect of melanin as an adsorbent of molybdenum.
Adsorption ; Animals ; Melanins ; chemistry ; metabolism ; Mice ; Mice, Hairless ; Mice, Transgenic ; Molybdenum ; chemistry ; metabolism ; pharmacology ; Skin ; chemistry ; drug effects ; Skin Pigmentation ; drug effects ; Water Pollutants, Chemical ; chemistry ; metabolism ; pharmacology

    Clinical research is essential for the practice of evidence-based medicine. This study reports on our current practice of clinical research support in Mito Kyodo General Hospital and discusses future challenges. In April 2013, the University of Tsukuba hired a clinical research assistant to provide clinical research support in Mito Kyodo General Hospital. The clinical research assistant worked full-time in the hospital in collaboration with 3 university faculty members. The target population for this study comprised 450 medical personnel including doctors, nurses, and other medical staff. From April 2014, 1 of the 3 faculty members visited the hospital once a month to offer clinical research consultations and deliver a lecture on nursing research. We analyzed past records of clinical research support and conducted a questionnaire survey to explore the level of satisfaction of the medical personnel. Four-hundred and ninety records of 91 research topics proposed by 68 medical personnel were identified. Of these, 93.4% were proposed by doctors or nurses. Most studies employed an observational study design (64.8%) and were conducted in order to make a presentation at an academic conference (51.1%). The consultation sessions were held 1–5 times, for 40–405 min, and lasted from 1–84 days per research topic. Consultations mostly pertained to research design and protocol planning (57.1%). Forty-seven clients were invited to participate in the questionnaire survey, 30 of whom provided valid responses. The results showed that 96.6% of the clients were satisfied with the consultations. The number of clients who participated in the consultations comprised only 15.1% of the target population. These practice biases need to be addressed in future. However, nearly all respondents were satisfied with the consultations. These findings suggest that our clinical research support was beneficial to medical personnel.

Case: A 40-year-old woman. Clinical diagnosis: Autistic disorder with mild mental retardation. Case report: The patient underwent pancreaticoduodenectomy for the treatment of her pancreatic cancer. We held several conferences with individuals from different medical fields and examined the influence of the patient's autistic disorder on the perioperative conditions. The senior author, a clinical psychologist, conducted repeated individual, acceptive, and sympathetic interviews with the patient and her family and maintained supportive relationships with them as an honorary family member. Thus, the clinical psychologist helped reduce the patient's anxiety about the medical treatment. Conclusion: The participation of a clinical psychologist in the medical conferences enabled the medical staff to understand the complications involved and provide mental support to the patient and her family. Palliat Care Res 2010; 5(2): 323-326

It is essential to prolong the term as possible in the treatment of threatened premature delivery. We report a case of threatened abortion successfully treated with hochuekkito. The patient was 31 year-old pregnant woman with lower abdominal pain. She was diagnosed to be at the risk of premature delivery on 21 weeks and 5 days of gestation. Intravenous ritodrine hydrochloride was started and she had to stay in bed. Severe side effects of ritodrine hydrochloride such as palpitation, tachycardia, tremor, nausea, and loss of appetite were appeared and she was consulted to our department on 23 weeks and 1 day of gestation. Those symptoms were markedly improved after administration of hochuekkito extract. She delivered a male infant of 1230g birth weight on 28 weeks of gestation. Hochuekkito suppressed severe side effects, and enabled to continue the infusion of ritodrine hydrochloride, suggesting the usefulness of Kampo therapy in the treatment of threatened premature delivery.

We report six cases with honton disease successfully treated with a combination of goshuyuto extract and ryokeijutsukanto extract. Five of the cases were diagnosed as panic disorder, and the remaining case as generalized anxiety disorder. All six cases complained of palpitation, nausea, dizziness, headache and anxiety attacks. We diagnosed them as a hontonto (Zhouhou fang) indication. Their various complaints disappeared after combination therapy with those extracts. Furthermore, efficacy of the combination therapy was proven to be equal to hontonto. These cases suggest that the combination therapy with goshuyuto extract and ryokeijutsukanto extract is useful in place of hontonto.