Objectives: Safety reports are core components of secure medical systems, but their significance have remained obscure, mostly owing to limited quantitative approaches other than the numbers of reports. In 2005, we developed “management levels” and their equally converted points (p) of scores, which indicated the grades of required correspondences of medical systems. Moreover, products of those scores multiplied by risk levels (equally converted scores), “total scores” were also proposed for weighting harmful events from biphasic aspects; severity of patient damage and the required levels of correspondence as medical systems. In this study, we assessed this scoring system using extensive longitudinal experience.Methods: Risk, management and total scores were retrospectively surveyed between 2012 and 2022 when a consistent reporting system had worked throughout the study period.Results: The aforementioned three scores inconsistently decreased along with a decrease in number of safety reports from 2,445 to 1,194 cases, or 2,069 to 1,052 cases/105 admitted patients (c/pap) in eleven years. Of the scores, the most prominent decrease was found in the management scores from 2,164 to 1,070 points/pap (p/pap). The risk and total scores had decreased even more modestly: from 1,879 to 1,484 p/pap, and 5,470 to 4,007 p/pap, respectively. When compared with the proportion (%) of risk and management levels in 2012, risk level 0 decreased, and risk level 1 and 3a increased in 2022. However, the proportion of management levels did not change during this period.Conclusion: The proposed scoring system showed that the cumulative severity of patient damage did not worsen, or decrease in some years accompanied by decreasing correspondence levels of the medical system, although the numbers of reports also decreased. These findings show the appropriateness of the on-going safety activities of this hospital even when restricted to reported events. However, their effectiveness including unreported events, requires further study.

Background/Aims: Endoscopic biliary drainage is the gold standard treatment for cholangitis. The two methods of biliary drainage are endoscopic biliary stenting and nasobiliary drainage. A novel integrated outside biliary stent and nasobiliary drainage catheter system (UMIDAS NB stent; Olympus Medical Systems) was recently developed. In this study, we evaluated the efficacy of this stent in the treatment of cholangitis caused by common bile duct stones or distal bile duct strictures. Methods: We conducted a retrospective pilot study by examining the medical records of patients who required endoscopic biliary drainage for cholangitis due to common bile duct stones or distal bile duct strictures, and who were treated with a UMIDAS NB stent, between December 2021 and July 2022. Results: Records of 54 consecutive patients were reviewed. Technical and clinical success rates were 47/54 (87.0%) and 52/54 (96.3%), respectively. Adverse events were observed in 12 patients, with six patients experiencing pancreatitis as an adverse event, following endoscopic retrograde cholangiopancreatography (ERCP). Regarding late adverse events, five cases of biliary stent migration into the bile duct were observed. Disease-related death occurred in one patient. Conclusions The outside-type UMIDAS NB stent is an efficacious new method for biliary drainage and can be applied to many indications.

This study was undertaken to elucidate the usefulness and problems of autologous blooddonation for the patients with low-lying placenta. Seventy-eight women with low-lying placentawho gave birth in our institution were retrospectively analyzed. Autologous blood donation wasperformed in 58 patients (74%). The median volume of donated blood was 300 mL. Patients withor without autologous blood donation showed no significant difference in the distance betweenthe edge of the placenta and the internal os of the uterus. Median blood loss due to intrapartumhemorrhage was 1183 mL. All 7 patients with blood loss of more than 2000 mL had donatedautologous blood. The donated blood was transfused in 9 of the 58 patients (16%) who underwentautologous blood donation. No patients underwent allogenic blood transfusion. Althoughautologous blood donation was expected to be useful for avoiding allogenic blood transfusion inthese patients with low-lying placenta, the high discard rate suggests the need for a strategy toselect those patients at high risk for blood loss requiring transfusion.

We report three cases of patients with mental illness suffering from symptoms associated with menstruation, which were improved with Kampo treatment. Case1: A 39-year-old female had been in a depressive state after delivery and diagnosed with persistent mood disorder in the Neuropsychiatry Department of Fukushima Medical University (FMU). During treatment for the disorder, she developed premenstrual dysphoric disorder (PMDD) and was immediately hospitalized. After she was introduced to the Obstetrics/Gynecology Department, we treated her with Kampo medicine such as tokakujokito considering the meaning of the pattern (sho), and then she recovered from PMDD. Case2: A 29-year-old female with schizophrenic disorder treated in the Neuropsychiatry Department of FMU was referred to the Obstetrics/Gynecology Department due to PMDD. We administered Kampo medicine such as kamishoyosan, nyosinsan and saikozai when yang pattern was observed, and ninjinto and daikenchuto in yin sho. Then, her condition then gradually improved. Case3: A 37-year-old female diagnosed with borderline personality disorder and attention deficit hyperactivity disorder was hospitalized in the Neuropsychiatry Department of FMU. She was introduced to the Obstetrics/Gynecology department due to dysmenorrhea and PMS. After she was treated with keishibukuryogan and hangekobokuto, her symptoms improved. In conclusion, Kampo treatment appears to be effective for symptoms associated with menstruation in women with mental illness.

PURPOSE: This study evaluated the availability of multi-directionally forged (MDF) titanium (Ti) as a component of removable partial dentures (RPDs). MDF-Ti remarkably improved the mechanical properties of RPDs due to its ultrafine-grained structure. MATERIALS AND METHODS: The wear resistance, plaque adhesion, and machinability of MDF-Ti were tested. As controls, commercially pure (CP) titanium was used for wear, plaque adhesion, and machinability tests. For wear resistance, the volume losses of the titanium teeth before and after wear tests were evaluated. Plaque adhesion was evaluated by the assay of Streptococcus mutans. In the machinability test, samples were cut and ground by a steel fissure bur and carborundum (SiC) point. An unpaired t-test was employed for the analysis of the significant differences between MDF-Ti and the control in the results for each test. RESULTS: Wear resistance and plaque adherence of MDF-Ti similar to those of CP-Ti (P>.05) were indicated. MDF-Ti exhibited significantly larger volume loss than CP-Ti in all conditions except 100/30,000 g/ rpm in machinability tests (P<.05). CONCLUSION Although the wear resistance and plaque adherence of MDFTi were comparable to those of controls, MDF-Ti showed better machinability than did CP-Ti. MDF-Ti could be used as a framework material for RPDs.

PURPOSE: This study evaluated the availability of multi-directionally forged (MDF) titanium (Ti) as a component of removable partial dentures (RPDs). MDF-Ti remarkably improved the mechanical properties of RPDs due to its ultrafine-grained structure. MATERIALS AND METHODS: The wear resistance, plaque adhesion, and machinability of MDF-Ti were tested. As controls, commercially pure (CP) titanium was used for wear, plaque adhesion, and machinability tests. For wear resistance, the volume losses of the titanium teeth before and after wear tests were evaluated. Plaque adhesion was evaluated by the assay of Streptococcus mutans. In the machinability test, samples were cut and ground by a steel fissure bur and carborundum (SiC) point. An unpaired t-test was employed for the analysis of the significant differences between MDF-Ti and the control in the results for each test. RESULTS: Wear resistance and plaque adherence of MDF-Ti similar to those of CP-Ti (P>.05) were indicated. MDF-Ti exhibited significantly larger volume loss than CP-Ti in all conditions except 100/30,000 g/ rpm in machinability tests (P<.05). CONCLUSION Although the wear resistance and plaque adherence of MDFTi were comparable to those of controls, MDF-Ti showed better machinability than did CP-Ti. MDF-Ti could be used as a framework material for RPDs.

We report a case of a 71 year-­old woman treated for diffuse panbronchiolitis (DPB). She received home oxygen therapy and was administered erythromycin ; however, sputum production, cough and respiratory dis­tress worsened. After hospitalization, she was treated with keishikyoshakuyakukasokyoto and acupuncture. After 30 days, respiratory distress, respiratory resistance measured with the pulseoscillation technique and the distance walked in the 6-­minute walk test improved. Thus, combination therapy comprising keishikyo­shakuyakukasokyoto and acupuncture seemed to be a beneficial therapy for an advanced case of DPB.

We examined 57 patients treated with Kampo decoctions containing uzu for 5 years and 3 months from September 2013. Sekiganryo, which was administered to 32 patients, was the most commonly used decoction. The value of uzu dosage and duration of administration were spread widely and the medians (ranges) are 8.0 (1.0-41.0)g/day and 180 (3-1700) days, respectively. Complete recovery, partial recovery, no recovery, and deterioration in terms of the chief complaint, were observed in 36, 11, 9, and 1 patients, respectively. The number of patients exhibiting complete or partial recovery was higher than that of patients showing no recovery or deterioration when the duration of uzu administration was more than one month and the dosage was higher than 4 g/day (p < 0.05). The patients treated with uzu more than 20 g/day were all sekiganryo administrated ones. Side effects were observed in three patients. Thus, under careful observation, uzu was safely used over a long term and at high doses.uzu: aconite root before processing

Purpose: The purpose of this study is to evaluate hangeshashinto rinse for oral discomfort in terminally-ill cancer patients and to compare the effectiveness of hangeshashinto rinse with or without honey rinse. Methods: Patients with oral discomfort were randomized to receive either hangeshashinto rinse or hangeshashinto with honey rinse as first-line treatment. Patients performed oral rinse three to five times a day for 2 weeks. Further, oral wetness, halitosis, oral mucositis, mouth discomfort, compliance of rinse were then evaluated before and after the intervention. Results: 144 patients were enrolled during this period and 22 patients completed the study (hangeshashinto 13 / hangeshashinto with honey 9). After the intervention, oral wetness was improved, and end-tidal concentration of hydrogen sulfide was decreased in both cases. Although there was no statistically significant difference, oral discomfort by subjective and objective evaluations, also and symptom of oral mucositis were improved. Other volatile sulfur compounds decreased. Frequency of rinsing between groups receiving hangeshashinto or hangeshashinto with honey did not differ, however, the acceptability was slightly better in the honey combination group. Conclusion: Both hangeshashinto rinse and hangeshashinto with honey rinse reduced end-tidal concentration of hydrogen sulfide and improved oral wetness. Oral rinse by hangeshashinto or hangeshashinto with honey may be effective for oral discomfort in terminally-ill cancer patients.