Since the introduction of vonoprazan, a potassium-competitive acid blocker (P-CAB), it has been demonstrated to reversibly inhibit gastric acid secretion by engaging in potassium-competitive ionic binding to H+/K+-ATPase. In contrast, proton pump inhibitors (PPIs) achieve H+/K+-ATPase inhibition through covalent binding to cysteine residues of the proton pump. Reported cases have indicated an emerging trend of P-CAB-related gastropathies, similar to those associated with PPIs, as well as unique gastropathies specific to P-CAB use, such as the identification of web-like mucus. Pathologically, parietal cell profusions, which show a positively correlated with hypergastrinemia, have a higher incidence in P-CAB users compared to PPI users. Thus, this review aims to summarize the endoscopic and pathological findings reported to date concerning P-CAB-related gastric mucosal lesions. Additionally, it seeks to discuss the differences between the PPIs and P-CABs in terms of the formation and frequency of associated gastropathies. This review highlights the evident differences in the mechanism of action and potency of acid inhibition between P-CABs and PPIs, notably contributing to differences in the formation and frequency of associated gastropathies. It emphasizes the necessity to distinguish between P-CAB-related and PPI-related gastropathies in the clinical setting.

The purpose of this study was to explore issues arising from the promotion of collaboration between general practitioners (GPs) and community pharmacists in the management of leftover medicine. The 2016 Revision of Medical Fee newly added the check boxes in the prescription form in which a physician requests the correspondence of a pharmacy when confirming leftover medicine. In this study, we conducted a questionnaire survey among GPs in three wards of Tokyo in the month of November 2016. Of the 1,256 clinics queried, 283 responded to the survey. Among those GPs responding, 86.6% were concerned about leftover medicine of their patients, while 29.3% used the check boxes. GPs who received an explanation about the change of the prescription form demonstrated a significant increase in the use of the check boxes, compared to GPs who did not (p<0.01). Of the GPs surveyed, 71.0% thought that the check boxes were an advantage in recognizing medicines that the patients did not take. An overall 67.5% of the GPs who used the check boxes revised prescriptions based on the information from pharmacists. The study suggests that by increasing collaboration between GPs and pharmacists, the information from pharmacists could be utilized to revise prescriptions and lead optimization of drug treatment.

Chronic expanding haematoma (CEH) is a rare type of haematoma that enlarges slowly and continuously without coagulation. It can occur following surgery because of shear stress-induced bleeding in the scar tissue between the subcutaneous fat and fascia. We present three cases of large chronic CEH that were successfully treated with triamcinolone injections. Three female patients developed large chronic CEH at 9 months, 5 years, and 6 years, respectively, after latissimus dorsi flap harvesting for breast reconstruction. Although the condition did not improve after multiple sessions of haematoma aspiration in the first two patients, it resolved following a single 40-mg triamcinolone injection along with appropriate compression dressing for several weeks. In the third patient, triamcinolone was injected immediately after the initial aspiration of the haematoma, and the condition improved considerably. There were no side effects in any of the patients. To the best of our knowledge, this is the first report of successful treatment of large CEH using triamcinolone. Therefore, we suggest that triamcinolone injections be considered for the treatment of CEH.
Bandages ; Cicatrix ; Fascia ; Female ; Free Tissue Flaps ; Hemorrhage ; Humans ; Mammaplasty ; Seroma ; Subcutaneous Fat ; Superficial Back Muscles* ; Triamcinolone*

In order to promote regional cooperation in palliative care, we developed a regional cooperation clinical pathway for home palliative care that offers simple support and is easy to use. We then administered a questionnaire survey to 14 healthcare professionals with various specialties who were involved in the introduction of the pathway, and we revised the pathway on the basis of the survey results. The revised pathway was then tested in 13 patients who were discharged from 3 designated cancer care hospitals in Toyama City to home care, and another questionnaire survey was conducted afterwards in the same manner. The mean overall score on the questionnaire was 2 in seven, 3 in seven (on a scale of 0 to 3) at the time of introduction, whereas the score after trial use was 1 in one, 2 in four, 3 in five. We believe that more innovative approaches to the implementation of such pathways are required.

Purpose and Methods: Aiming at the relief of suffering by the palliative care team and prompt information sharing between healthcare professionals with various specialties, We introduced new IT cloud system, carried out questionnaire survey and examined the usefulness to 11 persons of healthcare professionals. Five cases where the palliative care team was concerned during the hospitalize became a home palliative care to the tried half a year. Results: All the members were using the personal computer as an input device. Four persons were using the iPhone. Two persons had the experience inputted on the spot. Nine persons of the input time were 5 or less minutes. All the members were perusing at various places by various device. Urgently and vital mail was useful: 3 in six, 2 in three, 1 in one, 0 in one. Information content were suitable: 3 in nine, 2 in two. Cooperation were completed in the smooth: 3 in nine, 2 in two. Have you utilized EIR for the home palliative care?: 3 in nine, 2 in two. Conclution: To the support of information sharing and palliative care team by IT cloud system transduction, the useful probability was suggested in the home palliative care.

OBJECTIVE: The aim of this study was to investigate the prognostic factors and treatment outcome of patients with adenocarcinoma of the uterine cervix who underwent radical hysterectomy with systematic lymphadenectomy. METHODS: A total of 130 patients with stage IB to IIB cervical adenocarcinoma treated with hysterectomy and systematic lymphadenectomy from 1982 to 2005 were retrospectively analyzed. Clinicopathological data including age, stage, tumor size, the number of positive node sites, lymphovascular space invasion, parametrial invasion, deep stromal invasion (>2/3 thickness), corpus invasion, vaginal infiltration, and ovarian metastasis, adjuvant therapy, and survival were collected and Cox regression analysis was used to determine independent prognostic factors. RESULTS: An estimated five-year survival rate of stage IB1 was 96.6%, 75.0% in stage IB2, 100% in stage IIA, and 52.8% in stage IIB. Prognosis of patients with one positive-node site is similar to that of those with negative-node. Prognosis of patients with multiple positive-node sites was significantly poorer than that of negative and one positive-node site. Multivariate analysis revealed that lymph node metastasis, lymphovascular space invasion, and parametrial invasion were independent prognostic factors for cervical adenocarcinoma. Survival of patients with cervical adenocarcinoma was stratified into three groups by the combination of three independent prognostic factors. CONCLUSION: Lymph node metastasis, lymphovascular space invasion, and parametrial invasion were shown to be independent prognostic factors for cervical adenocarcinoma treated with hysterectomy and systematic lymphadenectomy.
Adenocarcinoma ; Cervix Uteri ; Female ; Humans ; Hysterectomy ; Lymph Node Excision ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Survival Rate ; Treatment Outcome ; Uterine Cervical Neoplasms

OBJECTIVE: Few studies on the prognosticators of the patients with recurrent endometrial cancer after relapse have been reported in the literature. The aim of this study was to determine the prognosticators after relapse in patients with recurrent endometrial cancer who underwent primary complete cytoreductive surgery and adjuvant chemotherapy. METHODS: Thirty-five patients with recurrent endometrial cancer were included in this retrospective analysis. The prognostic significance of several clinicopathological factors including histologic type, risk for recurrence, time to relapse after primary surgery, number of relapse sites, site of relapse, treatment modality, and complete resection of recurrent tumors were evaluated. Survival analyses were performed by Kaplan-Meier curves and the log-rank test. Independent prognostic factors were determined by multivariate Cox regression analysis. RESULTS: Among the clinicopathological factors analyzed, histologic type (p=0.04), time to relapse after primary surgery (p=0.03), and the number of relapse sites (p=0.03) were significantly related to survival after relapse. Multivariate analysis revealed that time to relapse after primary surgery (hazard ratio, 6.8; p=0.004) and the number of relapse sites (hazard ratio, 11.1; p=0.002) were independent prognostic factors for survival after relapse. Survival after relapse could be stratified into three groups by the combination of two independent prognostic factors. CONCLUSION: We conclude that time to relapse after primary surgery, and the number of relapse sites were independent prognostic factors for survival after relapse in patients with recurrent endometrial cancer.
Endometrial Neoplasms ; Female ; Humans ; Multivariate Analysis ; Recurrence ; Retrospective Studies ; Survival Analysis*

OBJECTIVESThe purpose of this study was to assess how changes from different baselines of activities of daily living (ADL) can be explained by marital status, living arrangement and healthcare.

METHODSUsing data from the Chinese Longitudinal Health Longevity Study conducted in 2002 and 2005, 8,099 surviving and 3,822 deceased elderly aged 65 years and over were evaluated using multinomial logistic regression.

RESULTSAfter adjusting for demographic, socioeconomic and health factors, elderly who were either married or living alone were less likely to encounter ADL decline compared to their counterparts. This was true only for those with fully independent ADL at baseline. Notably, once the functional status of the elderly declined from baseline and they became dependent on others, the status of living alone was no longer a significant predictor of the rate of future decline. On the other hand, elderly who had a spouse, children or other relatives as caregivers were more likely to experience a faster recovery and lower likelihood of death, compared to those who were cared by unrelated live-in caregivers. In addition, Chinese elderly with health insurance had a lower likelihood of death than their counterparts lacking health insurance, among those with ADL at the dependent baseline.

CONCLUSIONSAlthough there has been a change in family structure and living arrangements, the majority of Chinese elderly still rely on traditional forms of family support, especially after acquiring dependency status. As the elderly have different functional levels, healthcare policies in China should consider the need for both community and family support systems.

At Nippon Medical School, a "Basic Clinical Training Course" is provided as an introduction to clinical medicine. Medical students undergo initial clinical skills training with simulators. We describe the technique of effective training to acquire clinical skills and the results of student evaluations and a questionnaire survey.1) The training consisted of 8 practicums, including internal examination, funduscopic examination, otoscopic examination, breast examination, auscultation (heart sounds and lung sounds), and collection of blood samples. Medical students moved in rotation once per time period (45 minutes) and performed practical training in each unit, which comprised 2 practicums.2) The training with the prescribed number of 50 students in 4 time periods was efficiently performed for 2 days and required 9 trainers per day. Student evaluations and a questionnaire survey revealed the interest and enthusiasm of medical students and showed they thought highly of the training.3) The training was efficiently performed and was thought to help reduce the teaching load of instructors. The educational effect of the training can be strengthened by increasing the convenience of the clinical simulation laboratory, by reinforcing the education of clinical skills and attitudes in clinical clerkship, and by evaluating these factors after the completion of the clinical clerkship.

Concerning the bone structures of the mandible reconstructed by particular cellular bone and marrow (PCBM), platelet rich plasma (PRP) and tray, we have examined the possibility of implant insertion by clarifying the morphological conditions in each compact and cancellous bone on computed tomography (CT), and by observing the differences in their CT values.Using the computer software program Sim Plant (Materialize Dental, Leuven, Belgium), we morphologically observed 6 cases of implant inserted area after mandibular reconstruction and 11 cases of native bone, and examined the differences in their CT values. The osseointegration rate of each inserted implant was also evaluated.Compared with the native bone group, the PCBM reconstruction group had generally thin compact bone. In the over-3cm-length PCBM reconstruction group, the average CT value was 259.7 ± 94.4 HU (n = 3) in the cancellous bone, whereas in the native bone group, the average CT value was 528.9 ± 140.1 HU (n = 10). Therefore, the PCBM reconstruction group showed significantly lower CT value than the native bone group. However, in the under-3cm-length group, the PCBM reconstruction group showed no significant difference compared with the native bone group. The osseointegration rate of the inserted implants almost 6 months after insertion was 100% in the PCBM reconstruction group and 94.1% in the native bone group.Although the PCBM reconstructed bone had thinner cortical bone and showed lower CT value compared with the native bone, implant insertion was possible.