Purpose: Thyroid transcription factor 1 (TTF-1) expression is a useful predictor of treatment efficacy in advanced non-squamous non–small cell lung cancer (NSCLC). This study aimed to evaluate whether TTF-1 could predict the effectiveness of chemotherapy versus chemoimmunotherapy in patients with non-squamous NSCLC with programmed death ligand-1 (PD-L1) expression between 1% and 49%. Materials and Methods: We conducted a retrospective study of patients with NSCLC who were treated with chemotherapy or chemoimmunotherapy between March 2016 and May 2023. The patients had histologically confirmed NSCLC, stage III-IV or postoperative recurrence, TTF-1 measurements, and PD-L1 expression levels between 1% and 49%. Clinical data were analyzed to evaluate the effect of TTF-1 expression on treatment efficacy. Results: This study included 283 of 624 patients. TTF-1–positive patients showed longer progression-free survival (PFS) and overall survival (OS) (PFS: 6.4 months [95% confidence interval (CI), 5.0 to 9.4] vs. 4.1 months [95% CI, 2.7 to 6.1], p=0.03; OS: 17.9 months [95% CI, 15.2 to 28.1] vs. 9.4 months [95% CI, 6.3 to 17.0], p < 0.01) in the chemotherapy cohorts (n=93). In the chemoimmunotherapy cohort (n=190), there was no significant difference in PFS and OS between TTF-1–positive and –negative groups (PFS: 7.6 months [95% CI, 6.4 to 11.0] vs. 6.0 months [95% CI, 3.6 to 12.6], p=0.59; OS: 25.0 months [95% CI, 18.0 to 49.2] vs. 21.3 months [95% CI, 9.8 to 28.8], p=0.09). Conclusion In patients with NSCLC with PD-L1 expression between 1% and 49%, TTF-1 expression was a predictor of chemotherapeutic, but not chemoimmunotherapeutic, efficacy.

Insufficient treatment of mandibular fractures can result in malocclusion, often necessitating revision surgery. Therefore, appropriate surgical treatment by oral and maxillofacial surgeons with adequate consideration of the occlusion is crucial. Moreover, in patients with bone defects between the fractured ends, bone grafting may be required. A 48-year-old man was referred to our department with malocclusion after initial surgery for mandibular fracture performed by plastic surgeons at another hospital. We performed revision surgery with bone grafting for a bone defect, and favorable postoperative occlusion and bone healing were achieved. Occlusal reconstruction is paramount, and bone grafting may be required if the procedure creates a bone defect. The skills and technique of oral and maxillofacial surgeons are critical, although collaboration with plastic surgeons may be necessary.

Purpose: Thyroid transcription factor 1 (TTF-1) expression is a useful predictor of treatment efficacy in advanced non-squamous non–small cell lung cancer (NSCLC). This study aimed to evaluate whether TTF-1 could predict the effectiveness of chemotherapy versus chemoimmunotherapy in patients with non-squamous NSCLC with programmed death ligand-1 (PD-L1) expression between 1% and 49%. Materials and Methods: We conducted a retrospective study of patients with NSCLC who were treated with chemotherapy or chemoimmunotherapy between March 2016 and May 2023. The patients had histologically confirmed NSCLC, stage III-IV or postoperative recurrence, TTF-1 measurements, and PD-L1 expression levels between 1% and 49%. Clinical data were analyzed to evaluate the effect of TTF-1 expression on treatment efficacy. Results: This study included 283 of 624 patients. TTF-1–positive patients showed longer progression-free survival (PFS) and overall survival (OS) (PFS: 6.4 months [95% confidence interval (CI), 5.0 to 9.4] vs. 4.1 months [95% CI, 2.7 to 6.1], p=0.03; OS: 17.9 months [95% CI, 15.2 to 28.1] vs. 9.4 months [95% CI, 6.3 to 17.0], p < 0.01) in the chemotherapy cohorts (n=93). In the chemoimmunotherapy cohort (n=190), there was no significant difference in PFS and OS between TTF-1–positive and –negative groups (PFS: 7.6 months [95% CI, 6.4 to 11.0] vs. 6.0 months [95% CI, 3.6 to 12.6], p=0.59; OS: 25.0 months [95% CI, 18.0 to 49.2] vs. 21.3 months [95% CI, 9.8 to 28.8], p=0.09). Conclusion In patients with NSCLC with PD-L1 expression between 1% and 49%, TTF-1 expression was a predictor of chemotherapeutic, but not chemoimmunotherapeutic, efficacy.

Insufficient treatment of mandibular fractures can result in malocclusion, often necessitating revision surgery. Therefore, appropriate surgical treatment by oral and maxillofacial surgeons with adequate consideration of the occlusion is crucial. Moreover, in patients with bone defects between the fractured ends, bone grafting may be required. A 48-year-old man was referred to our department with malocclusion after initial surgery for mandibular fracture performed by plastic surgeons at another hospital. We performed revision surgery with bone grafting for a bone defect, and favorable postoperative occlusion and bone healing were achieved. Occlusal reconstruction is paramount, and bone grafting may be required if the procedure creates a bone defect. The skills and technique of oral and maxillofacial surgeons are critical, although collaboration with plastic surgeons may be necessary.

Purpose: Thyroid transcription factor 1 (TTF-1) expression is a useful predictor of treatment efficacy in advanced non-squamous non–small cell lung cancer (NSCLC). This study aimed to evaluate whether TTF-1 could predict the effectiveness of chemotherapy versus chemoimmunotherapy in patients with non-squamous NSCLC with programmed death ligand-1 (PD-L1) expression between 1% and 49%. Materials and Methods: We conducted a retrospective study of patients with NSCLC who were treated with chemotherapy or chemoimmunotherapy between March 2016 and May 2023. The patients had histologically confirmed NSCLC, stage III-IV or postoperative recurrence, TTF-1 measurements, and PD-L1 expression levels between 1% and 49%. Clinical data were analyzed to evaluate the effect of TTF-1 expression on treatment efficacy. Results: This study included 283 of 624 patients. TTF-1–positive patients showed longer progression-free survival (PFS) and overall survival (OS) (PFS: 6.4 months [95% confidence interval (CI), 5.0 to 9.4] vs. 4.1 months [95% CI, 2.7 to 6.1], p=0.03; OS: 17.9 months [95% CI, 15.2 to 28.1] vs. 9.4 months [95% CI, 6.3 to 17.0], p < 0.01) in the chemotherapy cohorts (n=93). In the chemoimmunotherapy cohort (n=190), there was no significant difference in PFS and OS between TTF-1–positive and –negative groups (PFS: 7.6 months [95% CI, 6.4 to 11.0] vs. 6.0 months [95% CI, 3.6 to 12.6], p=0.59; OS: 25.0 months [95% CI, 18.0 to 49.2] vs. 21.3 months [95% CI, 9.8 to 28.8], p=0.09). Conclusion In patients with NSCLC with PD-L1 expression between 1% and 49%, TTF-1 expression was a predictor of chemotherapeutic, but not chemoimmunotherapeutic, efficacy.

Insufficient treatment of mandibular fractures can result in malocclusion, often necessitating revision surgery. Therefore, appropriate surgical treatment by oral and maxillofacial surgeons with adequate consideration of the occlusion is crucial. Moreover, in patients with bone defects between the fractured ends, bone grafting may be required. A 48-year-old man was referred to our department with malocclusion after initial surgery for mandibular fracture performed by plastic surgeons at another hospital. We performed revision surgery with bone grafting for a bone defect, and favorable postoperative occlusion and bone healing were achieved. Occlusal reconstruction is paramount, and bone grafting may be required if the procedure creates a bone defect. The skills and technique of oral and maxillofacial surgeons are critical, although collaboration with plastic surgeons may be necessary.

When treating finger, hand, and elbow trauma (hereinafter, surgically treated hand trauma) in self-employed farmers, it is also necessary to consider how the patient will be able to continue working in the family business. This study investigated return-to-work outcomes of self-employed farmers in the Tokachi area in Hokkaido, Japan after surgically treated hand trauma. A survey was conducted with 56 self-employed farmers (39 men and 17 women, median age 55 years). More than 80% of the farmers (n = 49) returned to their previous work, and most returned to work during the farming season while still experiencing functional impairment. Self-employed farmers with surgically treated hand trauma tend to return to work in time for the farming season regardless of the severity of functional impairment they are experiencing, and it is important for health care providers to recognize this fact and consider return-to-work support as part of the treatment plan in addition to treatment itself. Therefore, providers must understand the processes and details of tasks performed during each farming season and devise individualized measures to accommodate patients returning to work while still experiencing impairment. In cases where multiple treatments are required, such as two-stage functional reconstruction, it is also important that the treatment plan consider the farming season, for example, by having the patient temporarily return to work and then undergo surgery during the off season.

The balance between treatment and farming work must be considered when performing hand surgery in farmers, but no studies have previously examined the level of busyness in farmers in detail. We conducted a questionnaire survey on busyness by month and desirable time for hand surgery in 20 self-employed farmers in the Tokachi region of Hokkaido who had undergone hand surgery. Busyness in crop farming peaked approximately in May for fertilizer application, sowing, and raising and transplanting seedlings and in August-October for harvesting and transporting crops. On the other hand, livestock farmers were busy with rearing management throughout the year, with a peak of busyness in May-October for fertilizer application, sowing, and harvesting and transporting forage crop. Given the approximately 3-month period of work restriction following hand surgery, all respondents wished to have this period from November to January. If a farmer is injured during the peak farming period, a treatment plan is required that supports an early return to work and allows for two-stage reconstruction and treatment of degenerative disease in the quiet period for farming. Meanwhile, almost no respondents expected to receive support from official organizations and manufacturers, indicating that there is a need to provide the government with information from a medical perspective.

Objective: Lenvatinib is an oral multitarget tyrosine kinase inhibitor (mTKI) and is recommended for patients with advanced hepatocellular carcinoma (HCC) with Child-Pugh A liver function, who are not amenable to surgical resection, locoregional treatment, or transcatheter arterial chemoembolization. Hepatogastric fistula is a rare complication with a poor prognosis in patients with HCC. Previous reports on fistula formation during mTKI therapy for HCC were all associated with sorafenib. Here, we report the first case of recurrent hepatogastric fistula during lenvatinib therapy for advanced HCC managed using an over-the-scope clip (OTSC).Patient: We present the case of a 73-year-old man with alcoholic liver cirrhosis who was treated for multiple HCC for 7 years. HCC was treated using repetitive transcatheter arterial chemoembolization, radiofrequency ablation, and sorafenib. Owing to disease progression, lenvatinib treatment was started. During lenvatinib treatment, recurrent hepatogastric fistulas developed. An OTSC was useful for fistula closure and prevention of recurrence.Results: The major cause of fistula formation is considered to be the direct invasion of HCC; however, HCC treatment might also be a contributing factor in our case. In addition, OTSC was useful for fistula closure.Conclusion: Clinicians should be aware of the fatal complications during HCC treatment.

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.