Patients with heart failure often have difficulty in stopping cardiotonic drugs as the disease stage progresses, and long-term hospitalization is a factor that significantly reduces quality of life. To solve this problem, in September 2017, our hospital started an initiative to support overnight stays at home by using a portable precision infusion pump and continuously injecting cardiotonic drugs with the approval of the hospital’s medical ethics committee. Since there are few case reports of similar efforts in Japan, here we describe the use of drugs and the content of the intervention by pharmacists. The drug is administered via a peripherally inserted central venous catheter using an ambulatory precision infusion pump. The pharmacist calculates the drug dose and flow rate required during the at-home period using spreadsheet software, and proposes a prescription to the doctor. In addition, if multiple cardiotonics and diuretics are administered, the presence or absence of compounding changes is confirmed, and the feasibility of mixing should be examined, and then prepared aseptically on a clean bench on the day of administration. We started to administer catecholamine while in the hospital on the day before the stay at home. Then we prepared the catecholamine in a portable precision infusion pump and administered it during stay at home. To date, we have supported 8 cases in stays at home without emergency hospitalization or sudden death due to exacerbation of heart failure.

Objective：To research studies on patients with head and neck cancer who underwent laryngectomy (patients with laryngectomy) in terms of function, activity, participation, and environment, and examine quality of life (QOL) -related factors.Methods：The participants were patients who underwent laryngectomy and belonged to the Japanese Laryngectomy Clubs. We investigated basic attributes, QOL, sarcopenia, neck and upper limb function, and upper limb-related activities of daily living (ULADL). Statistical analysis was performed using multiple logistic regression analysis after correlation analysis to investigate QOL-related factors.Results：The number of valid responders was 272 patients, median age was 74.0 years, median postoperative follow-up was 8.7 years, and 94 were still employed after surgery. Multiple logistic regression analysis results revealed that factors related to QOL included ULADL, sarcopenia, and neck and upper limb function.Conclusions：The QOL-related factors of laryngectomy were neck and upper limb function, ULADL, and sarcopenia. Rehabilitation for these factors is considered important in improving QOL.

This study examined and improved the quality of inter-professional moral case deliberation (MCD) in a home-based medical care clinic by altering the MCD process and evaluating it using the REFLECT rubric. After altering the MCD process, four of the five main evaluation items in the questionnaire were shifted to a higher evaluation level employing a scaled evaluation. The free-entry field revealed future tasks. This report suggested that improving the quality and assessment of MCD using REFLECT promotes the reflection skills of clinical teams.

Objective: Combination therapy with glecaprevir and pibrentasvir (G/P) has been shown to provide a sustained virologic response (SVR) rate of >97% in patients with chronic hepatitis C virus (HCV) infection in the first published real-world Japanese data. However, a recently published study showed that the treatment was often discontinued in patients ≥75 years old, resulting in low SVR in intention-to-treat (ITT) analysis. Thus, our aim was to evaluate real-world data for G/P therapy in patients ≥75 years of age, the population density of which is high in “rural” regions.Patients and Methods: We conducted a multicenter study to assess the efficacy and safety of G/P therapy for chronic HCV infection, in the North Kanto area in Japan.Results: Of the 308 patients enrolled, 294 (95.5%) completed the treatment according to the protocol. In ITT and per-protocol analyses, the overall SVR12 rate was 97.1% and 99.7%, respectively. The old-aged patients group consisted of 59 participants, 56 of whom (94.9%) completed the scheduled protocol. Although old-aged patients tended to have non-SVR factors such as liver cirrhosis, history of HCC, and prior DAA therapies, the SVR12 rates in old-aged patients were 98.3% and 100% in the ITT and PP analyses, respectively. Of 308 patients enrolled, adverse events were observed in 74 patients (24.0%), with grade ≥3 events in 8 patients (2.6%). There was no significant difference in any grade and grade ≥3 adverse events between the old-aged group and the rest of the study participants. Only one patient discontinued the treatment because of adverse events.Conclusion: G/P therapy is effective and safe for old-aged patients.

Background: and Purpose Although numerous measures for stroke exist, stroke remains one of the leading causes of death in Japan. In this study, we aimed to determine the long-term survival rate after first-ever stroke using data from a large-scale population-based stroke registry study in Japan. Methods: Part of the Shiga Stroke and Heart Attack Registry, the Shiga Stroke Registry is an ongoing population-based registry study of stroke, which covers approximately 1.4 million residents of Shiga Prefecture in Japan. A total 1,880 patients with non-fatal first-ever stroke (among 29-day survivors after stroke onset) registered in 2011 were followed up until December 2016. Five-year cumulative survival rates were estimated using the Kaplan-Meier method, according to subtype of the index stroke. Cox proportional hazards models were used to assess predictors of subsequent all-cause death. Results: During an average 4.3-year follow-up period, 677 patients died. The 5-year cumulative survival rate after non-fatal first-ever stroke was 65.9%. Heterogeneity was present in 5-year cumulative survival according to stroke subtype: lacunar infarction, 75.1%; large-artery infarction, 61.5%; cardioembolic infarction, 44.9%; intracerebral hemorrhage, 69.1%; and subarachnoid hemorrhage, 77.9%. Age, male sex, Japan Coma Scale score on admission, and modified Rankin Scale score before stroke onset were associated with increased mortality during the chronic phase of ischemic and hemorrhagic stroke. Conclusions In this study conducted in a real-world setting of Japan, the 5-year survival rate after non-fatal first-ever stroke remained low, particularly among patients with cardioembolic infarction and large-artery infarction in the present population-based stroke registry.

BACKGROUND: The health effects of biological aerosols on the respiratory system are unclear. The purpose of this study was to clarify the association of airborne particle, protein, and endotoxin with emergency department visits for asthma in Kyoto City, Japan. METHODS: We collected data on emergency department visits at a hospital in Kyoto from September 2014 to May 2016. Fine (aerodynamic diameter ≤ 2.5 μm) and coarse (≥ 2.5 μm) particles were collected in Kyoto, and protein and endotoxin levels were analyzed. The association of the levels of particles, protein, endotoxin, and meteorological factors (temperature, relative humidity, wind speed, and air pressure) with emergency department visits for asthma was estimated. RESULTS: There were 1 to 15 emergency department visits for asthma per week, and the numbers of visits increased in the autumn and spring, namely many weeks in September, October, and April. Weekly concentration of protein in fine particles was markedly higher than that in coarse particles, and protein concentration in fine particles was high in spring months. Weekly endotoxin concentrations in fine and coarse particles were high in autumn months, including September 2014 and 2015. Even after adjusting for meteorological factors, the concentrations of coarse particles and endotoxin in both particles were significant factors on emergency department visits for asthma. CONCLUSIONS Our results suggest that atmospheric coarse particles and endotoxin are significantly associated with an increased risk of asthma exacerbation.
Adolescent ; Adult ; Aged ; Air Pollutants ; analysis ; Asthma ; epidemiology ; Child ; Emergency Service, Hospital ; statistics & numerical data ; Endotoxins ; analysis ; Female ; Humans ; Japan ; epidemiology ; Male ; Middle Aged ; Particle Size ; Particulate Matter ; analysis ; Proteins ; analysis ; Seasons ; Weather ; Young Adult

BACKGROUND/AIMS: Anti-tumor necrosis factor drugs (anti-TNF) and thiopurines are important treatment options in patients with inflammatory bowel disease (IBD), including during pregnancy. However, there are limited data on the benefit/risk profile of anti-TNF and thiopurines during pregnancy in Asia. The aim of this study was to analyze pregnancy outcomes of female Japanese IBD patients treated with anti-TNF and/or thiopurines. METHODS: This cross-sectional study assessed pregnancy outcomes in 72 women with IBD. Pregnancy outcomes were compared among 31 pregnancies without exposure to infliximab (IFX), adalimumab (ADA), or thiopurines; 24 pregnancies with exposure to anti-TNF treatment (23 IFX, 1 ADA); 7 pregnancies with exposure to thiopurines alone; and 10 pregnancies with exposure to both IFX and thiopurines. RESULTS: Thirty-five of the 41 pregnancies (85.3%) that were exposed to anti-TNF treatment and/or thiopurines resulted in live births after a median gestational period of 38 weeks. Of the 35 live births, 3 involved premature deliveries; 7, low birth weight; and 1, a congenital abnormality. There were 6 spontaneous abortions in pregnancies that were exposed to anti-TNF treatment (17.7%). Pregnancy outcomes among the 4 groups were similar, except for the rate of spontaneous abortions (P =0.037). CONCLUSIONS: Exposure to anti-TNF treatment or thiopurines during pregnancy was not related to a higher incidence of adverse pregnancy outcomes in Japanese IBD patients except for spontaneous abortion.
Adalimumab ; Abortion, Spontaneous ; Asia ; Asian Continental Ancestry Group ; Congenital Abnormalities ; Cross-Sectional Studies ; Female ; Humans ; Incidence ; Infliximab ; Infant, Low Birth Weight ; Infant, Newborn ; Inflammatory Bowel Diseases* ; Japan* ; Live Birth ; Necrosis* ; Pregnancy ; Pregnancy Outcome* ; Pregnancy*

Until the Sui Dynasty in China, night sweat and spontaneous perspiration had been thought to be caused by same pathophysiology, that is, lowered superficial resistance by deficiency of Qi.In the Tang Dynasty, these were considered to have different pathophysiologies and a new principle indicated that pathogenic heat caused night sweat.In the Song and Jing Dynasties, deficiency of blood and pathogenic heat by deficiency of Yin was also considered to cause night sweat.In the Jing Dynasty, exogenous pathogens, such as Cold were considered to cause night sweat, which indicated the principle that not only the deficiency syndrome but also the excess syndrome caused night sweat.In the beginning of the Yuan and Ming Dynasties, it was concluded that the deficiency of Yin caused night sweat and the deficiency of Yang caused spontaneous perspiration.In the middle of the Ming Dynasty, another new theory indicated that deficiency of Yang also possibly caused night sweat; therefore we should diagnose abnormal sweat depending on the pathophysiology in each case.In the Qing Dynasty, new theories were established stating that not only exogenous pathogens but also Damp-heat, undigested food and stagnation of blood, all of which are included in excess syndrome, cause night sweat, and that based on which part of the body sweats occurred we might understand pathophysiology of night sweat. The night sweat by Warm-heat, which is different from the one by Wind-cold, was considered to be caused with deficiency of Yin.Thus we conclude that the theories of night sweat developed over time, based on Chinese medical classics.

A total of 147 subjects presenting with common colds were discussed in the context of traditional Japanese medicine. Using diagnoses and treatment based on traditional Japanese medicine, the subjects were divided into three groups, including wind-cold and wind-heat, and were prescribed herbal medicines. The subjects were compared in terms of time-of-onset, complaints, subjective and objective symptoms, and constitution.1) Wind-cold was observed in 42.9% of their cases, mostly treated with kakkonto/keishito. This type of common cold occurred frequently during winter but was less common in summer. Many patients were found to have a weak stomach and/or an excessive sensitivity to cold. Typical symptoms were chills (often the chief complaint) and cold sensations in the limbs, both of which are external cold symptoms. There were no objective symptoms other than a floating pulse. 2) The percentage of wind-heat colds was 46.3%. Gingyosan was frequently used. This type of common cold occurred more frequently in spring, but was also seen in autumn. Slightly more subjects were sensitive to heat and/or had a healthy constitution. Symptoms were extensive, including external/internal heat symptoms, such as pharyngeal pain (often the chief complaint), redness of the pharynx, hot sensation, feverishness, dry mouth favoring cold water, and dryness symptoms and, less often, cold state symptoms. 3) The remaining subjects, accounting for 10.9%, were regarded as a complex of cold and heat states, and were treated with kufugedokuto.